scholarly journals A Retrospective Analysis of the Effect of Combination of Pure Fish Oil with Third Generation Lipid Emulsion on Liver Function in Children on Long-Term Parenteral Nutrition

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2495
Author(s):  
Mikołaj Danko ◽  
Aleksandra Żyła-Pawlak ◽  
Janusz Książyk ◽  
Katarzyna Olszewska-Durkacz ◽  
Marta Sibilska ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Parenteral Nutrition ◽  
Fish Oil ◽  
Retrospective Analysis ◽  
Lipid Emulsion ◽  
Intestinal Failure ◽  
Third Generation ◽  
Glutamyl Transferase

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.

scholarly journals Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit

2020 ◽  
Vol 9 (11) ◽  
pp. 3393
Author(s):  
Sanghoon Lee ◽  
Se In Sung ◽  
Hyo Jung Park ◽  
Yun Sil Chang ◽  
Won Soon Park ◽  
...  
Keyword(s):  
Liver Disease ◽  
Birth Weight ◽  
Fish Oil ◽  
Neonatal Intensive Care ◽  
Lipid Emulsion ◽  
Intestinal Failure ◽  
Direct Bilirubin ◽  
Low Birth Weight Infants ◽  
Life Threatening

Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven® (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.

Long-Term Fish Oil Lipid Emulsion Use in Children With Intestinal Failure–Associated Liver Disease

2016 ◽  
Vol 41 (6) ◽  
pp. 930-937 ◽  
Author(s):  
Prathima Nandivada ◽  
Gillian L. Fell ◽  
Paul D. Mitchell ◽  
Alexis K. Potemkin ◽  
Alison A. O’Loughlin ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fish Oil ◽  
Lipid Emulsion ◽  
Intestinal Failure

Parenteral Nutrition Associated Liver Toxicity: Prevention, Diagnosis and Management

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.

Parenteral Nutrition Associated Liver Toxicity: Prevention, Diagnosis and Management

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.

scholarly journals Fish Oil Lipid Emulsion-Associated Sea-Blue Histiocyte Syndrome in a Pediatric Patient

2015 ◽  
Vol 20 (3) ◽  
pp. 217-221
Author(s):  
Ting Ting Wu ◽  
David S. Hoff
Keyword(s):  
Bone Marrow ◽  
Parenteral Nutrition ◽  
Fish Oil ◽  
Soybean Oil ◽  
Total Parenteral Nutrition ◽  
Pediatric Patient ◽  
Lipid Emulsion

A syndrome of hepatosplenomegaly, thrombocytopenia, and anemia and the presence of sea-blue histiocytes in bone marrow has been associated with parenteral soybean oil administration in patients receiving long-term total parenteral nutrition (TPN). A case is described here where this syndrome was observed in a pediatric patient who received long-term parenteral fish oil nutrition.

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