Intravenous Fish Oil Monotherapy as a Source of Calories and Fatty Acids Promotes Age-Appropriate Growth in Pediatric Patients with Intestinal Failure-Associated Liver Disease

J Pediatr. 2020 Apr;219:98-105.e4. doi: 10.1016/j.jpeds.2019.12.065. Epub 2020 Feb 12.

Abstract

Objective: To compare growth in children with intestinal failure-associated liver disease (IFALD) who received a fish oil intravenous lipid emulsion (FOLE) to those who received a soybean oil intravenous lipid emulsion (SOLE).

Study design: This multisite, retrospective study pair-matched FOLE (n = 82) to SOLE recipients (n = 41) using baseline serum direct bilirubin levels and postmenstrual age. Study subjects received open-label FOLE (1 g/kg/day) until IFALD resolved or parenteral nutrition was stopped. Historical control subjects received SOLE (up to 3 g/kg/day). Growth measures (changes in body weight, height/length, and head circumference), prealbumin, triglycerides, and glucose were compared between groups over time using the Wilcoxon rank-sum test.

Results: Although changes in all of the growth measures were similar for both groups (P > .05), FOLE recipients demonstrated an overall improved growth trajectory. After 28 weeks, FOLE recipients had a mean body weight within a z score range of -1 to 1 indicating age-appropriate growth. FOLE recipients consistently had higher prealbumin, lower triglyceride, and more normal glucose concentrations over time compared with SOLE recipients.

Conclusions: Children with IFALD who received FOLE had similar growth and fewer metabolic abnormalities compared with those who received SOLE.

Trial registration: Clinicaltrials.gov: NCT00910104 and NCT00738101.

Keywords: Omegaven; cholestasis; fish oil; lipid emulsion; parenteral nutrition; soybean oil.

Publication types

  • Multicenter Study

MeSH terms

  • Case-Control Studies
  • Child, Preschool
  • Energy Intake
  • Fat Emulsions, Intravenous
  • Fatty Acids
  • Female
  • Fish Oils / administration & dosage*
  • Growth / drug effects*
  • Humans
  • Intestinal Diseases / therapy*
  • Liver Diseases / therapy*
  • Male
  • Parenteral Nutrition / methods*
  • Retrospective Studies

Substances

  • Fat Emulsions, Intravenous
  • Fatty Acids
  • Fish Oils

Associated data

  • ClinicalTrials.gov/NCT00910104
  • ClinicalTrials.gov/NCT00738101