Treatment outcomes of pediatric patients on high dose pure fish oil-based fat emulsion: A retrospective study

Pure fish oil-based fat emulsion (FO-ILE) dosed at 1 g/kg/day is FDA approved for the treatment of intestinal failure associated liver disease. However, this limited fat provision can lead to suboptimal weight gain and excessive caloric intake from dextrose, particularly in neonates. There is limited data on the use of FO-ILE at doses higher than 1 g/kg/day. This study describes our experience with pediatric patients receiving 1.5 g/kg/day of FO-ILE.

A retrospective chart review was performed on patients receiving parenteral nutrition aged 0-18 years and receiving FO-ILE at a dose of 1.5 g/kg/day for at least 14 days. Clinical outcomes of interest included weight gain, glucose infusion rates (GIRs) and adverse effects including cholestasis, postprocedure hemorrhage, hypertriglyceridemia and essential fatty acid (EFA) deficiency.

Nine patients (range 2 months-12.9 years) receiving 1.5 g/kg/day of FO-ILE were included. Seven patients showed improved weight gain. Decrease of GIR was noted in four patients. One patient experienced worsening cholestasis with no clear etiology which prompted the decrease of FO-ILE to 1 g/kg/day with later resolution of cholestasis. Seven patients underwent invasive procedures, with one patient experiencing more than expected bleeding after circumcision not necessitating a decrease in dose. None of the patients developed hypertriglyceridemia. Eight patients had an EFA panel collected, all within normal limits.

Our findings suggest that higher doses of FO-ILE may be safe and beneficial in patients with suboptimal weight gain, and elevated GIR. Larger and long-term studies are required to validate these observations.