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Favorable Outcomes of Preterm Infants With Parenteral Nutrition-associated Liver Disease Treated With Intravenous
Michael Sorrell1, Alvaro Moreira, Kay Green
1*Department of Pediatrics, University of Texas Health Science Center San Antonio †Neonatal Intensive Care Unit, University Health System ‡Department of Pharmacy, University Health System, San Antonio §Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, Austin ||Pharmacotherapy Education and Research Center, University of Texas Health Science Center San Antonio ¶Neonatal Nutrition and Bone Institute, University Health System #San Antonio Military Medical Center, San Antonio, TX **Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Intravenous fish oil lipid emulsion (FishLE) safely reversed parenteral nutrition-associated liver disease (PNALD) in preterm infants. While growth was comparable, long-term cognitive and motor scores require further evaluation.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition-associated liver disease (PNALD) is a serious complication in preterm infants with intestinal failure.
- Current treatments for PNALD have limitations, necessitating novel therapeutic approaches.
Purpose of the Study:
- To evaluate the acute and long-term outcomes of preterm infants treated with an intravenous fish oil-based lipid emulsion (FishLE) for PNALD.
Main Methods:
- A cohort of preterm infants (14 days to 24 months) with PNALD received 1 g/kg/day of FishLE.
- Infants were monitored for liver function, growth, and developmental scores at 6 and 12 months postmenstrual age (PMA), compared to gestational age-matched controls.
Main Results:
- FishLE treatment led to the resolution of cholestasis in all thirteen treated infants without acute adverse events.
- Weight and head circumference were similar between FishLE-treated infants and controls at 6 and 12 months PMA.
- Cognitive and motor scores were reduced in FishLE-treated infants at 6 and 12 months PMA, though logistic regression indicated prolonged hospitalization, not FishLE treatment, was detrimental.
Conclusions:
- Intravenous FishLE is a safe and effective therapy for reversing PNALD in preterm infants with liver disease and intestinal failure.
- Long-term developmental follow-up is recommended for preterm infants treated with FishLE for PNALD.
Objectives:
The aim of the study was to determine the acute and long-term outcomes of preterm infants treated with an intravenous fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD).
Methods:
Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin ≥4 mg/dL, and requiring >60% calories from parenteral nutrition were eligible. Enrolled infants received 1 g · kg · day of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition. Acute clinical effects and biochemical markers of liver function were monitored. Growth and developmental scores at 6 and 12 months postmenstrual age (PMA) were assessed and compared with controls matched by gestational age (GA).
Results:
Thirteen patients with mean GA of 28 ± 4 weeks were treated and compared with 119 GA-matched controls. Their mean direct bilirubin was 9.8 ± 6.4 mg/dL at enrollment. All infants had resolution of cholestasis after study completion. There were no acute adverse events, deaths, or liver/intestinal transplants. Weight and head circumference were similar between FishLE-treated patients and controls at 6- and 12-month PMA. Cognitive and motor scores were decreased at 6 and 12 months PMA in FishLE-treated infants. Logistic regression analysis showed that prolonged hospitalization was detrimental to cognitive and motor development, whereas treatment was not.
Conclusions:
The use of intravenous FishLEs in premature infants appears to be safe and reverses PNALD despite significant liver disease and intestinal failure. This therapy should be used in preterm infants with PNALD and followed long term to evaluate development.
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