Reversal of Parenteral Nutrition–Associated Liver Disease in Two Infants With Short Bowel Syndrome Using Parenteral Fish Oil: Implications for Future Management

Abstract

Here we report the reversal of cholestasis in 2 infants with intestinal failure and parenteral nutrition-associated liver disease. Treatment involved the substitution of a conventional intravenous fat emulsion with one containing primarily omega-3 fatty acids. Biochemical tests of liver function improved significantly. One child was removed from the liver transplantation list because of improved hepatic function, and the second child had complete resolution of cholestasis while solely on parenteral nutrition. This suggests that fat emulsions made from fish oils may be an effective means of treating and preventing this often-fatal condition. A randomized, controlled trial is necessary to study the efficacy of this new approach to parenteral nutrition-associated liver disease.

Inhibition of neuroblastoma cell proliferation with omega-3 fatty acids and treatment of a murine model of human neuroblastoma using a diet enriched with omega-3 fatty acids in combination with sunitinib

“…The Soy diet is most similar to the average Western diet (ω-6/ω-3 ~10:1-30:1), whereas the M/S diet is modeled after the NIH recommendations (ω-6/ω-3 ~2:1-1:1). In contrast, the Men diet is highly enriched in ω-3 FAs and is analogous to the intravenous lipid emulsion used to successfully reverse total parenteral nutrition-associated cholestasis (14). In this study, only the Men diet significantly inhibited tumor growth, supporting the idea that the efficacy of ω-3 FAs is closely correlated with the ω-6/ω-3 ratio and less so with the total ω-3 content.…”

Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease

“…14,15,21 One such product, Omegaven (Fresenius Kabi AG, Bad Homburg, Germany), has been administered to two neonatal patients with PNALD, in a recent report, with excellent success in reversing the process. 14 Gura et al 14 in reporting this encouraging experience called for randomized controlled trials testing lipid preparations that are high in omega-3 vs standard lipid preparations, as a means of preventing PNALD. We agree with this suggestion, adding that some of these prevention trials should focus on NICU patients who are at a very high risk of developing PNALD.…”

“…We studied all neonates in this system with dates of birth from 1 January, 2002 through 30 June, 2006, who received at least 14 days of PN. We hypothesized that this information would help us focus new experimental strategies for preventing PNALD, such as Omegaven use, [12][13][14][15][16] on patients at highest risk for developing PNALD.…”

Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions

“…The estimation of the sample size was based on the reported incidence of IFALD in infants, which is reported to vary from 30% to 60% [26], and on the prevalence of 20% of IFALD in this population in our NICU, from January 2010 to June 2011 (unpublished data). A sample size of 150 individuals in each group was estimated to detect a difference of 20% incidence between the two groups with 90% power, 95% confidence and 20% loss to follow-up.…”