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Higher Doses of Fish Oil–Based Lipid Emulsions Used to Treat Inadequate Weight Gain and Rising Triene:Tetraene Ratio in a Severely Malnourished Infant With Intestinal Failure–Associated Liver Disease
Author(s) -
Riedy Mary,
DePaula Brittany,
Puder Mark,
Gura Kathleen M.,
Sztam Kevin A.
Publication year - 2017
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607116661031
Subject(s) - intestinal failure , medicine , fish oil , parenteral nutrition , cholestasis , gastroenterology , liver disease , weight gain , body weight , endocrinology , fish <actinopterygii> , biology , fishery
Fish oil–based lipid emulsions (FOLEs) have been used to treat cholestasis in children with intestinal failure–associated liver disease (IFALD). When FOLEs are dosed at 1 g/kg/d, essential fatty acid (EFA) deficiency typically does not occur. We describe the clinical course of a severely malnourished parenteral nutrition–dependent infant with IFALD. Baseline EFA panels were normal upon starting FOLE at 1 g/kg/d. Despite biochemical improvement in IFALD, weight velocity was below target and biochemical EFA status worsened, even after correction for other factors affecting weight. The FOLE dose was increased to 1.5 g/kg/d, resulting in improvement of weight velocity and EFA status. This suggests that in severely malnourished infants being treated for IFALD, higher doses of FOLE may be required for adequate growth and to prevent EFA deficiency.