P172 Third generation lipid emulsions with fish oil in intestinal failure patients on long term parenteral nutrition: do they help doing better?

Background: Deterioration of liver function, or intestinal failure-associated liver disease, is often observed in long-term parenterally fed children. Fish oil-based intravenous lipids have been reported to play a role in the prevention and treatment of intestinal failure associated liver disease. Methods: This retrospective analysis included 40 pediatric patients, (20 male and 20 female), median age 38 months (range 1.5–200 months) on long-term (≥1 month) parenteral nutrition who received the parenteral mixtures containing a combination of a third-generation lipid emulsion and pure fish oil because of laboratory liver function abnormalities. The total dose of fish oil from both emulsions for each patient exceeded 0.5 g/kg/day. Data from visits in an outpatient clinic were retrospectively analyzed using the Wilcoxon test, Mann-Whitney test, and Spearman correlation test. Results: The median time of therapy was 149 days (range 28–418 days). There was a decrease of median total and direct (conjugated) bilirubin concentration from 22.23 µmol/L (range 3.42–243 µmol/L) to 10.26 µmol/L (range 3.42–180.58 µmol/L; p < 0.005) and 8.55 (range 1.71–212.04 µmol/L) to 6.84 µmol/L (range 1.71–150.48 µmol/L; p < 0.007) respectively. A significant decrease in median alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase was also observed. In 11 patients bilirubin concentrations increased or remained unchanged. When compared to the patients who responded to the combination therapy, the patients who did not respond received parenteral nutrition for a longer time prior to the start of the therapy (51 vs. 30 months; p < 0.05). Conclusions: The mixture of an intravenous lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil with the addition of pure fish oil emulsion may be helpful in the treatment of liver complications in children on long-term parenteral nutrition.

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Plasma and Red Blood Cell PUFAs in Home Parenteral Nutrition Paediatric Patients—Effects of Lipid Emulsions

Nutrients ◽

10.3390/nu12123748 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3748

Author(s):

Antonella Lezo ◽

Valentina D’Onofrio ◽

Maria Paola Puccinelli ◽

Teresa Capriati ◽

Antonella De Francesco ◽

...

Keyword(s):

Fatty Acids ◽

Blood Cell ◽

Parenteral Nutrition ◽

Fish Oil ◽

Red Blood Cell ◽

Healthy Children ◽

Lipid Emulsions ◽

Mead Acid ◽

Paediatric Patients

Background: Mixed lipid emulsions (LE) containing fish oil present several advantages compared to the sole soybean oil LE, but little is known about the safety of essential fatty acids (EFA) profile in paediatric patients on long-term Parenteral Nutrition (PN). Aim of the study: to assess glycerophosfolipid polyunsaturated fatty acids (PUFA) levels on plasma and red blood cell (RBC) membrane of children on long term PN with composite LE containing fish oil (SMOF), and to compare it with a group receiving olive oil LE (Clinoleic®) and to the reference range for age, previously determined on a group of healthy children. Results: A total of 38 patients were enrolled, median age 5.56 (0.9–21.86) years, 15 receiving Clinoleic®, 23 receiving SMOF. Patients on SMOF showed significantly higher levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower levels of arachidonic acid (ARA) and Mead acid (MEAD)/ARA ratio in plasma and RBC compared with patients on Clinoleic® and with healthy children. Triene:tetraene (T:T) ratio of both groups of patients did not differ from that of healthy children-median plasma (MEAD/ARA: 0.01, interquartile rage (IQR) 0.01, p = 0.61 and 0.02, IQR 0.02, p = 0.6 in SMOF and Clinoleic® patients, respectively), and was considerably lower than Holman index (>0.21). SMOF patients showed no statistically significant differences in growth parameters compared with Clinoleic® patients. Patients of both groups showed stiffness class F0-F1 of liver stiffness measure (LSM) 5.6 (IQR 0.85) in SMOF patients and 5.3 (IQR 0.90) in Clinoleic® patients, p = 0.58), indicating absence of liver fibrosis. Conclusions: Fatty acids, measured as concentrations (mg/L), revealed specific PUFA profile of PN patients and could be an accurate method to evaluate nutritional status and eventually to detect essential fatty acid deficiency (EFAD). SMOF patients showed significantly higher EPA, DHA and lower ARA concentrations compared to Clinoleic® patients. Both LEs showed similar hepatic evolution and growth.

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Parenteral nutrition with fish oil-based lipid emulsion reduces the risk of cholestasis in preterm infants

Journal of International Medical Research ◽

10.1177/03000605211011805 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110118

Author(s):

Yi-Ling Wang ◽

Lih-Ju Chen ◽

Lon-Yen Tsao ◽

Hsiao-Neng Chen ◽

Cheng-Han Lee ◽

...

Keyword(s):

Parenteral Nutrition ◽

Fish Oil ◽

Soybean Oil ◽

Preterm Infants ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Lipid Emulsion ◽

Very Low Birth Weight ◽

Lipid Emulsions

Objective Preterm infants receive long-term parenteral nutrition (PN) for gastrointestinal immaturity. This study aimed to determine if mixed lipid emulsions containing fish oil decrease the incidence of PN-associated cholestasis by reducing oxidative stress and providing an anti-inflammatory effect. Methods This retrospective cohort study enrolled 399 very low birth weight premature infants (gestational age ≤32 weeks) between January 2009 and November 2017 at a single neonatal intensive care unit. Preterm infants received total PN with either mixed lipid emulsion including fish oil (SMOFlipid®, n = 195) or soybean oil-based lipid emulsion (Lipovenoes®, n = 204) for at least 7 days. We compared the outcomes of PN-associated cholestasis, comorbidities, and mortality between the groups. Results The incidence of PN-associated cholestasis was significantly lower in the SMOFlipid group than in the Lipovenoes group. The duration to full feeding days was significantly shorter in the SMOFlipid group compared with the Lipovenoes group. Relevant complications, such as severe retinopathy of prematurity and bronchopulmonary dysplasia, were also significantly reduced in the SMOFlipid group compared with the Lipovenoes group. Conclusion In premature infants, PN with fish oil-based lipid emulsions is associated with a lower incidence of PN-associated cholestasis compared with soybean oil-based lipid emulsions.

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Parenteral Nutrition Associated Liver Toxicity: Prevention, Diagnosis and Management

10.2310/gastro.9059 ◽

2017 ◽

Author(s):

Meredith A. Baker ◽

Lorenzo Anez-Bustillos ◽

Duy T. Dao ◽

Gillian L. Fell ◽

Kathleen M. Gura ◽

...

Keyword(s):

Liver Disease ◽

Liver Function ◽

Parenteral Nutrition ◽

Fish Oil ◽

Liver Toxicity ◽

Lipid Emulsions ◽

Older Children ◽

Key Factors ◽

Prevention And Treatment

Long-term parenteral nutrition (PN) treatment is limited by parenteral nutrition–associated liver disease (PNALD), which is characterized initially by intrahepatic cholestasis, typically defined as a direct bilirubin greater than 2 mg/dL in the absence of other causes of liver disease. PNALD is typically less common and less severe and progresses more slowly in older children and adults than in infants. The etiology of PNALD is multifactorial. Key factors include immature liver function, sepsis, and a lack of enteral nutrition. Additionally, nearly every component of PN has been attributed to or exacerbated hepatotoxicity. PN preparations must be carefully individualized and monitored to minimize hepatotoxicity from its various components. Although many hepatotoxic components or imbalances have been recognized, soybean oil–based lipid emulsions continue to be widely used as they are the only lipid emulsions currently approved for PN by the Food and Drug Administration. Fish oil–based lipid emulsions have been shown to reverse PNALD, with an associated decrease in mortality. As such, fish oil therapy should be considered early once biochemical cholestasis is detected in PN-dependent patients. Studies investigating the use of novel lipid emulsions for prevention and treatment of PNALD are ongoing. This review contains 5 figures, 5 tables, and 114 references.

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The Effect of Fish Oil-Based Lipid Emulsion and Soybean Oil-Based Lipid Emulsion on Cholestasis Associated with Long-Term Parenteral Nutrition in Premature Infants

Gastroenterology Research and Practice ◽

10.1155/2016/4139164 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Leilei Wang ◽

Jing Zhang ◽

Jiejin Gao ◽

Yan Qian ◽

Ya Ling

Keyword(s):

Birth Weight ◽

Parenteral Nutrition ◽

Fish Oil ◽

Soybean Oil ◽

Premature Infants ◽

Lipid Emulsion ◽

Lipid Emulsions ◽

Feeding Intolerance ◽

Total Dosage

Purpose. To retrospectively study the effect of fish oil-based lipid emulsion and soybean oil-based lipid emulsion on cholestasis associated with long-term parenteral nutrition in premature infants.Methods. Soybean oil-based lipid emulsion and fish oil-based lipid emulsion had been applied in our neonatology department clinically between 2010 and 2014. There were 61 qualified premature infants included in this study and divided into two groups. Soybean oil group was made up of 32 premature infants, while fish oil group was made up of 29 premature infants. Analysis was made on the gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, age at which feeding began, usage of lipid emulsions, and incidence of cholestasis between the two groups.Results. There were no statistical differences in terms of gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, and age at which feeding began. Besides, total incidence of cholestasis was 21.3%, and the days of life of occurrence of cholestasis were53±5.0days. Incidence of cholestasis had no statistical difference in the two groups.Conclusion. This study did not find the different role of fish oil-based lipid emulsions and soybean oil-based lipid emulsions in cholestasis associated with long-term parenteral nutrition in premature infants.

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Parenteral Nutrition Associated Liver Toxicity: Prevention, Diagnosis and Management

10.2310/im.9059 ◽

2017 ◽

Author(s):

Meredith A. Baker ◽

Lorenzo Anez-Bustillos ◽

Duy T. Dao ◽

Gillian L. Fell ◽

Kathleen M. Gura ◽

...

Keyword(s):

Liver Disease ◽

Liver Function ◽

Parenteral Nutrition ◽

Fish Oil ◽

Liver Toxicity ◽

Lipid Emulsions ◽

Older Children ◽

Key Factors ◽

Prevention And Treatment

Long-term parenteral nutrition (PN) treatment is limited by parenteral nutrition–associated liver disease (PNALD), which is characterized initially by intrahepatic cholestasis, typically defined as a direct bilirubin greater than 2 mg/dL in the absence of other causes of liver disease. PNALD is typically less common and less severe and progresses more slowly in older children and adults than in infants. The etiology of PNALD is multifactorial. Key factors include immature liver function, sepsis, and a lack of enteral nutrition. Additionally, nearly every component of PN has been attributed to or exacerbated hepatotoxicity. PN preparations must be carefully individualized and monitored to minimize hepatotoxicity from its various components. Although many hepatotoxic components or imbalances have been recognized, soybean oil–based lipid emulsions continue to be widely used as they are the only lipid emulsions currently approved for PN by the Food and Drug Administration. Fish oil–based lipid emulsions have been shown to reverse PNALD, with an associated decrease in mortality. As such, fish oil therapy should be considered early once biochemical cholestasis is detected in PN-dependent patients. Studies investigating the use of novel lipid emulsions for prevention and treatment of PNALD are ongoing. This review contains 5 figures, 5 tables, and 114 references.

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