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Risk of post-procedural bleeding in children on intravenous fish oil
Prathima Nandivada1, Lorenzo Anez-Bustillos1, Alison A O'Loughlin1
1Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Insights
Parenteral fish oil (FO) therapy for intestinal failure-associated liver disease (IFALD) in children shows a low risk of significant bleeding. This study found the bleeding incidence comparable to the general population, suggesting FO can continue during procedures.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Nutrition
Background:
- Intestinal failure-associated liver disease (IFALD) is a serious complication managed with parenteral fish oil (FO) therapy.
- Concerns exist regarding a potential increased bleeding risk associated with FO monotherapy.
Purpose of the Study:
- To determine the incidence of clinically significant post-procedural bleeding (CSPPB) in pediatric patients receiving FO monotherapy for IFALD.
Main Methods:
- Retrospective chart review of patients treated with intravenous FO for IFALD.
- Analysis of invasive procedures and occurrence of CSPPB within one month.
- CSPPB defined by re-operation, ICU transfer, re-admission, or death.
Main Results:
- 183 patients underwent 732 invasive procedures while on FO therapy.
- Clinically significant post-procedural bleeding (CSPPB) occurred in 0.68% of procedures (95% CI 0.22-1.59%).
- FO therapy was not interrupted, and no bleeding-related deaths were reported.
Conclusions:
- Parenteral fish oil (FO) therapy for IFALD in children appears safe.
- The risk of CSPPB is not higher than in the general pediatric population.
- Omega-3 fatty acids (O3FA) should not be discontinued before procedures or during bleeding events.
Background:
Intestinal failure-associated liver disease (IFALD) can be treated with parenteral fish oil (FO) monotherapy, but practitioners have raised concerns about a potential bleeding risk. This study aims to describe the incidence of clinically significant post-procedural bleeding (CSPPB) in children receiving FO monotherapy.
Methods:
A retrospective chart review was performed on patients at our institution treated with intravenous FO for IFALD. CSPPB was defined as bleeding leading to re-operation, transfer to the intensive care unit, re-admission, or death, up to one month after any invasive procedure.
Results:
From 244 patients reviewed, 183 underwent ≥1 invasive procedure(s) (n = 732). Five (0.68%, 95% CI 0.22-1.59%) procedures resulted in CSPPB. FO therapy was never interrupted. No deaths due to bleeding occurred.
Conclusions:
Findings suggest that FO therapy is safe, with a CSPPB risk no greater than that reported in the general population. O3FA should not be held in preparation for procedures or in the event of bleeding.
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