Changing the Paradigm: Omegaven for the Treatment of Liver Failure in Pediatric Short Bowel Syndrome

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 48; no. 2; pp. 209 - 215
• Main Authors: Diamond, Ivan R, Sterescu, Anca, Pencharz, Paul B, Kim, Jae H, Wales, Paul W
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01.02.2009; Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Child, Preschool; cholestasis; Cohort Studies; Fat Emulsions, Intravenous; Fatty Acids, Omega-3 - administration & dosage; Fatty Acids, Omega-3 - therapeutic use; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Infant; Intestine, Small - transplantation; Liver - drug effects; Liver - physiology; Liver Failure - chemically induced; Liver Failure - drug therapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; omega‐3 fatty acids; Other diseases. Semiology; parenteral nutrition; Parenteral Nutrition, Total - adverse effects; Recovery of Function; Retrospective Studies; short bowel syndrome; Short Bowel Syndrome - therapy; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Pediatrics; Hepatic disease; Short bowel syndrome; Biliary tract disease; Liver failure; Intestinal malabsorption; Hepatology; Gastroenterology; cholestasis-omega-3 fatty acids-parenteral nutrition-short bowel syndrome. Society for Pediatric Gastroenterology; and Nutrition and North American Society for Pediatric Gastroenterology; Intestinal disease; Child; Nutritional status; Human; Obesity; Nutrition disorder; Metabolic diseases; Parenteral nutrition; Fatty acids; Parenteral administration; Feeding; Treatment; and Nutrition; Cholostasis; Digestive diseases
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0b013e318182c8f6

ABSTRACT Background: Parenteral omega‐3 fatty acids, such as Omegaven, may benefit patients with pediatric short bowel syndrome (SBS) who develop parenteral nutrition–associated liver disease (PNALD). Patients and Methods: Retrospective cohort describing the outcome of all 12 children with SBS and advanced PNALD who were treated with Omegaven (target omega‐6 to omega‐3 fatty acid ratio = 1:1 to 2:1). Results: The median age was 7.5 (range 3.6–46) months, and median parenteral nutrition duration before starting Omegaven was 28.4 (range 15.3–55.3) weeks. Median initial serum conjugated bilirubin was 137 (range 54–203) μmol/L (8.06 [3.18–11.94] mg/dL). Of the 12 patients, 9 had complete and sustained resolution of hyperbilirubinemia within a median of 24 (range 7–37) weeks, and all are no longer being considered for liver transplantation. Improvements in markers of hepatic inflammation as well as nutritional status also were noted in these patients. Three patients received a liver‐intestine transplant while taking Omegaven. There were no complications attributable to Omegaven. Conclusions: Omegaven is associated with restoration of liver function in patients with SBS and advanced liver disease. Parenteral omega‐3 fatty acids, such as Omegaven, have the potential to fundamentally alter the paradigm of neonatal SBS from one of early death or transplantation from liver failure to a more chronic disease. More children with SBS should achieve full enteral tolerance and those who do not have the capacity for intestinal adaptation should be able to survive and receive an intestinal graft when older.