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Use of Fish Oil-Based Lipid Emulsions in Infants With Intestinal Failure-Associated Liver Disease: A Case Series
David E St-Jules1, Corilee A Watters1, Lynn M Iwamoto1
1Department of Human Nutrition, Food and Animal Science, University of Hawai'i at Manoa, Honolulu, Hawai'i (DES, CAW).
Insights
Fish oil-based lipid emulsions (FOLE) show promise for treating liver disease in infants with short bowel syndrome. This study suggests FOLE is safe and effective, normalizing bilirubin levels and aiding transition off parenteral nutrition.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Nutrition
Background:
- Intestinal failure-associated liver disease (IFALD) is a serious complication in infants with short bowel syndrome.
- Fish oil-based lipid emulsions (FOLE) are being investigated as a treatment for IFALD, but more data on safety and efficacy in pediatric populations is needed.
Purpose of the Study:
- To evaluate the safety and efficacy of fish oil-based lipid emulsions (FOLE) in infants with short bowel syndrome and IFALD.
- To assess the impact of FOLE on direct bilirubin levels, transition to enteral feeding, growth, and essential fatty acid deficiency.
Main Methods:
- Retrospective chart review of 10 infants with short bowel syndrome receiving FOLE for IFALD.
- Analysis of direct bilirubin concentrations, feeding status, growth parameters, and fatty acid deficiency markers.
Main Results:
- Direct bilirubin levels normalized in surviving infants within 4.1 to 22.7 weeks.
- A trend toward reduced hospital stay was observed with earlier FOLE initiation (P = .058).
- Significant improvements in direct bilirubin and transition from parenteral to enteral feeding occurred within 6 weeks; no impaired growth or essential fatty acid deficiency was noted.
Conclusions:
- Fish oil-based lipid emulsions (FOLE) appear to be a safe and effective treatment for IFALD in infants with short bowel syndrome.
- Further research is required to confirm FOLE's role in preventing or shortening the duration of cholestasis.
Abstract:
The use of fish oil-based lipid emulsions (FOLE) in the treatment of intestinal failure-associated liver disease (IFALD) remains investigational. Additional evidence for safety and efficacy, particularly in the neonatal and pediatric populations, is needed. Retrospective chart review was conducted on 10 infants with short bowel syndrome who received FOLE for IFALD. Direct bilirubin concentrations normalized in surviving subjects within 4.1 to 22.7 weeks of starting treatment. Although earlier initiation of FOLE was not associated with more rapid normalization of direct bilirubin concentrations, it trended toward a significant correlation with reduced length of hospital stay (P = .058). The reduction in direct bilirubin levels and transition from parenteral to enteral feeding were statistically significant within 6 weeks of initiating the FOLE. Subjects did not have impaired growth and did not develop an essential fatty acid deficiency. These infants were discharged from the hospital 7.9 to 42.3 weeks after starting FOLE treatment, and 2 infants had transitioned completely off parenteral nutrition at discharge. In this study, FOLE appeared to be a safe and effective treatment for IFALD in infants with short bowel syndrome. Future studies are necessary to determine whether FOLE can help to prevent or shorten the duration of cholestasis.
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