Intravenous Fish Oil Monotherapy as a Source of Calories and Fatty Acids Promotes Age-Appropriate Growth in Pediatric Patients with Intestinal Failure-Associated Liver Disease

• Published in: The Journal of pediatrics Vol. 219; pp. 98 - 105.e4
• Main Authors: Gura, Kathleen, Premkumar, Muralidhar H., Calkins, Kara L., Puder, Mark
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2020
• Subjects: Case-Control Studies; Child, Preschool; cholestasis; Energy Intake; Fat Emulsions, Intravenous; Fatty Acids; Female; fish oil; Fish Oils - administration & dosage; Growth - drug effects; Humans; Intestinal Diseases - therapy; lipid emulsion; Liver Diseases - therapy; Male; Omegaven; parenteral nutrition; Parenteral Nutrition - methods; Retrospective Studies; soybean oil; CRP; FOLE; UCLA; PMA; soybean oil; BCH; fish oil; Omegaven; SOLE; parenteral nutrition; cholestasis; TCH; lipid emulsion; IFALD; IF; DB; PN
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2019.12.065

To compare growth in children with intestinal failure-associated liver disease (IFALD) who received a fish oil intravenous lipid emulsion (FOLE) to those who received a soybean oil intravenous lipid emulsion (SOLE). This multisite, retrospective study pair-matched FOLE (n = 82) to SOLE recipients (n = 41) using baseline serum direct bilirubin levels and postmenstrual age. Study subjects received open-label FOLE (1 g/kg/day) until IFALD resolved or parenteral nutrition was stopped. Historical control subjects received SOLE (up to 3 g/kg/day). Growth measures (changes in body weight, height/length, and head circumference), prealbumin, triglycerides, and glucose were compared between groups over time using the Wilcoxon rank-sum test. Although changes in all of the growth measures were similar for both groups (P > .05), FOLE recipients demonstrated an overall improved growth trajectory. After 28 weeks, FOLE recipients had a mean body weight within a z score range of −1 to 1 indicating age-appropriate growth. FOLE recipients consistently had higher prealbumin, lower triglyceride, and more normal glucose concentrations over time compared with SOLE recipients. Children with IFALD who received FOLE had similar growth and fewer metabolic abnormalities compared with those who received SOLE. Clinicaltrials.gov: NCT00910104 and NCT00738101.