Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit
Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oi...
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MDPI AG
2020-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3393 |
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| author | Sanghoon Lee Se In Sung Hyo Jung Park Yun Sil Chang Won Soon Park Jeong-Meen Seo |
| author_facet | Sanghoon Lee Se In Sung Hyo Jung Park Yun Sil Chang Won Soon Park Jeong-Meen Seo |
| author_sort | Sanghoon Lee |
| collection | DOAJ |
| description | Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven<sup>®</sup> (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy. |
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| language | English |
| last_indexed | 2024-03-10T15:24:08Z |
| publishDate | 2020-10-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ebba59bdd32a4ddca1340347137e733e2023-11-20T18:13:37ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-01911339310.3390/jcm9113393Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care UnitSanghoon Lee0Se In Sung1Hyo Jung Park2Yun Sil Chang3Won Soon Park4Jeong-Meen Seo5Intestinal Rehabilitation Team, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaDepartment of Pediatrics and Adolescents, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaIntestinal Rehabilitation Team, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaDepartment of Pediatrics and Adolescents, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaDepartment of Pediatrics and Adolescents, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaIntestinal Rehabilitation Team, 81 Irwon-ro, Gangnam-gu, Seoul 06351, KoreaIntestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven<sup>®</sup> (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.https://www.mdpi.com/2077-0383/9/11/3393intestinal failure-associated liver diseaseparenteral nutritionintravenous lipid emulsionfish oilprematureinfant |
| spellingShingle | Sanghoon Lee Se In Sung Hyo Jung Park Yun Sil Chang Won Soon Park Jeong-Meen Seo Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit Journal of Clinical Medicine intestinal failure-associated liver disease parenteral nutrition intravenous lipid emulsion fish oil premature infant |
| title | Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit |
| title_full | Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit |
| title_fullStr | Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit |
| title_full_unstemmed | Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit |
| title_short | Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit |
| title_sort | fish oil monotherapy for intestinal failure associated liver disease on smoflipid in the neonatal intensive care unit |
| topic | intestinal failure-associated liver disease parenteral nutrition intravenous lipid emulsion fish oil premature infant |
| url | https://www.mdpi.com/2077-0383/9/11/3393 |
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