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United States Department of Agriculture

Agricultural Research Service

Research Project: ABSORPTION AND METABOLISM OF ESSENTIAL MINERAL NUTRIENTS IN CHILDREN Title: Fish oil–based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: An ongoing positive experience

Authors
item Premkumar, Muralidhar -
item Carter, Beth -
item Hawthorne, Keli -
item King, Kristi -
item Abrams, Steven -

Submitted to: Advances in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: October 10, 2013
Publication Date: January 2, 2014
Citation: Premkumar, M.H., Carter, B.A., Hawthorne, K.M., King, K., Abrams, S.A. 2014. Fish oil–based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: An ongoing positive experience. Advances in Nutrition. 5(1):65-70.

Interpretive Summary: Parenteral nutrition-associated liver disease (PNALD) is a life threatening disease with high mortality and morbidity. Although total parenteral nutrition aids in treating extremely low-birth-weight infants, its long-term use is associated with severe morbidities such as PNALD. In this study, we showed the beneficial effect of fish oil-based lipid emulsions (FOLEs) in treating parenteral (intravenous) nutrition-associated liver disease. A total of 97 infants received FOLE. Eighty-three (86%) recovered and survived and 14 (14%) died. The median conjugated bilirubin (CB) concentration at the initiation of FOLE therapy was 4.8 mg/dL. The median time to recovery was 40 days. Our experience with the use of FOLE in PNALD continues to be encouraging. Prematurity continues to be a major determinant in mortality and severity of cholestasis. This calls for further research designed to optimize dose and timing of intervention in the use of FOLE in neonates.

Technical Abstract: We previously reported the beneficial effect of fish oil-based lipid emulsions (FOLEs) as monotherapy in the treatment of parenteral nutrition-associated liver disease (PNALD). In this report, we share our ongoing experience at Texas Children's Hospital, Houston, in the use of FOLE in treatment of PNALD as presented at the 2013 Experimental Biology meeting. We describe the findings of a single center, prospective, observational study of infants <6 mo of age with PNALD who received parenteral FOLE as monotherapy. A total of 97 infants received FOLE under the compassionate-use protocol for the treatment of PNALD. Eighty-three (86%) survived with resolution of cholestasis and 14 (14%) died. The median conjugated bilirubin (CB) concentration at the initiation of FOLE therapy was 4.8 mg/dL (range 2.1–26). The median time to resolution of cholestasis was 40 d (range 3–158). Compared with infants with mild cholestasis (CB of 2.1–5 mg/dL at the initiation of FOLE), nonsurvivors were significantly more premature and took longer to resolve their cholestasis. Gestational age at birth correlated inversely with CB at the beginning of FOLE and peak CB. Infants with an initial CB >10 mg/dL had a higher mortality rate than infants with an initial CB <5 mg/dL (35% vs. 6%; P < 0.05). Our experience with the use of FOLE in PNALD continues to be encouraging. Prematurity continues to be a major determinant in mortality and severity of cholestasis. This calls for further controlled studies designed to optimize dose and timing of intervention in the use of FOLE in neonates.

Last Modified: 11/24/2014
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