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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Improved outcome in neonatal short bowel syndrome using parenteral fish oil in combination with ω-6/9 lipid emulsions
Gertrud Angsten1, Yigael Finkel, Steven Lucas
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Parenteral fish oil and ω-6/9 lipid emulsions improved outcomes for neonates with short bowel syndrome (SBS) and liver disease. This approach may enhance intestinal adaptation and reduce liver failure in infants receiving parenteral nutrition (PN).
Area of Science:
- Neonatology
- Gastroenterology
- Hepatology
Background:
- Newborn infants with short bowel syndrome (SBS) are at high risk for fatal intestinal failure-associated liver disease (IFALD).
- Soybean oil-based lipid emulsions in parenteral nutrition (PN) may contribute to IFALD development.
- Infants possess significant capacity for intestinal adaptation if IFALD can be prevented or reversed.
Purpose of the Study:
- To compare the efficacy of parenteral fish oil (Omegaven) combined with ω-6/9 lipid emulsions (ClinOleic) versus traditional soybean oil-based emulsions (Intralipid) in neonates with SBS.
- To evaluate the impact of lipid emulsion composition on IFALD reversal and mortality in this population.
Main Methods:
- Retrospective study comparing 20 neonates with SBS treated with fish oil/ω-6/9 emulsions to 18 historical controls receiving soybean oil-based emulsions.
- Analysis of outcomes including direct bilirubin levels, time to reversal, and liver failure mortality.
Main Results:
- The treatment group (fish oil/ω-6/9 emulsions) showed reversal of cholestasis in all 14 survivors with IFALD within a median of 2.9 months.
- Mortality due to liver failure was significantly lower in the treatment group (10%) compared to the historical cohort (33%).
- The treatment group included extremely premature infants (median gestational age 26 weeks) compared to the historical group (35.5 weeks).
Conclusions:
- Parenteral fish oil combined with ω-6/9 lipid emulsions demonstrates improved outcomes in premature neonates with SBS.
- This mixed lipid emulsion strategy may promote intestinal adaptation and increase the IFALD-free period compared to soybean-based emulsions.
- The findings suggest a potential shift in lipid emulsion use for PN in SBS patients to mitigate liver disease risk.
Background:
Newborn infants with short bowel syndrome (SBS) represent a high-risk group of developing intestinal failure-associated liver disease (IFALD), which may be fatal. However, infants have a great capacity for intestinal growth and adaptation if IFALD can be prevented or reversed. A major contributing factor to IFALD may be the soybean oil-based intravenous lipid emulsions used since the introduction of parenteral nutrition (PN) 40 years ago.
Methods:
This retrospective study compares the outcome in 20 neonates with SBS treated with parenteral fish oil (Omegaven) in combination with ω-6/9 lipid emulsions (ClinOleic) with the outcome in a historical cohort of 18 patients with SBS who received a soybean oil-based intravenous lipid emulsion (Intralipid).
Results:
Median gestational age was 26 weeks in the treatment group and 35.5 weeks in the historical group. All patients were started on PN containing Intralipid that was switched to ClinOleic/Omegaven in the treatment group at a median age of 39 gestational weeks. In the treatment group, direct bilirubin levels were reversed in all 14 survivors with cholestasis (direct bilirubin >50 umol/L). Median time to reversal was 2.9 months. Only 2 patients died of liver failure (10%). In the historical cohort, 6 patients (33%) died of liver failure, and only 2 patients showed normalization of bilirubin levels.
Conclusions:
Parenteral fish oil in combination with ω-6/9 lipid emulsions was associated with improved outcome in premature neonates with SBS. When used instead of traditional soybean-based emulsions, this mixed lipid emulsion may facilitate intestinal adaptation by increasing the IFALD-free period.
