Changing the Paradigm: Omegaven for the Treatment of Liver Failure in Pediatric Short Bowel Syndrome
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 a...
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Published in | Journal of pediatric gastroenterology and nutrition Vol. 48; no. 2; pp. 209 - 215 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MD
Lippincott Williams & Wilkins, Inc
01.02.2009
Lippincott Williams & Wilkins |
Subjects | |
Online Access | Get full text |
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Abstract | 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. |
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AbstractList | 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).
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).
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) micromol/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.
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. 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. 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. |
Author | Kim, Jae H Diamond, Ivan R Sterescu, Anca Wales, Paul W Pencharz, Paul B |
AuthorAffiliation | Group for Improvement of Intestinal Function and Treatment, The Hospital for Sick Children, Toronto, Canada |
AuthorAffiliation_xml | – name: Group for Improvement of Intestinal Function and Treatment, The Hospital for Sick Children, Toronto, Canada |
Author_xml | – sequence: 1 givenname: Ivan R surname: Diamond fullname: Diamond, Ivan R organization: The Hospital for Sick Children – sequence: 2 givenname: Anca surname: Sterescu fullname: Sterescu, Anca organization: The Hospital for Sick Children – sequence: 3 givenname: Paul B surname: Pencharz fullname: Pencharz, Paul B organization: The Hospital for Sick Children – sequence: 4 givenname: Jae H surname: Kim fullname: Kim, Jae H organization: The Hospital for Sick Children – sequence: 5 givenname: Paul W surname: Wales fullname: Wales, Paul W email: paul.wales@sickkids.ca organization: The Hospital for Sick Children |
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Keywords | 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 |
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Notes | Supported, in part, by a fellowship award from the Canadian Institutes of Health Research, with additional support from the Surgeon Scientist Training Program, Department of Surgery, University of Toronto (I.R.D.). The authors report no conflicts of interest. Presented, in part, at the annual meeting of the Canadian Association of Paediatric Surgeons, St John's, Newfoundland, August 23–26, 2007. |
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Background:
Parenteral omega‐3 fatty acids, such as Omegaven, may benefit patients with pediatric short bowel syndrome (SBS) who develop parenteral... BACKGROUND:Parenteral omega-3 fatty acids, such as Omegaven, may benefit patients with pediatric short bowel syndrome (SBS) who develop parenteral... Parenteral omega-3 fatty acids, such as Omegaven, may benefit patients with pediatric short bowel syndrome (SBS) who develop parenteral nutrition-associated... |
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SubjectTerms | 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 |
Title | Changing the Paradigm: Omegaven for the Treatment of Liver Failure in Pediatric Short Bowel Syndrome |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1097%2FMPG.0b013e318182c8f6 http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00005176-200902000-00012 https://www.ncbi.nlm.nih.gov/pubmed/19179884 |
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