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Elimination of Soybean Lipid Emulsion in Parenteral Nutrition and Supplementation With Enteral Fish Oil Improve Cholestasis in Infants With Short Bowel Syndrome
Author(s) -
Rollins Michael D.,
Scaife Eric R.,
Jackson W. Daniel,
Meyers Rebecka L.,
Mulroy Cecilia W.,
Book Linda S.
Publication year - 2010
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533610361477
Subject(s) - medicine , parenteral nutrition , fish oil , short bowel syndrome , cholestasis , enteral administration , soybean oil , lipid emulsion , emulsion , gastroenterology , fish <actinopterygii> , intensive care medicine , biochemistry , pathology , fishery , biology , chemistry
Background Parenteral nutrition–associated liver disease (PNALD) is a potentially fatal complication for children with intestinal failure. Fish oil–based lipid emulsions have shown promise for the treatment of PNALD but are not readily available. Six cases are presented in which cholestasis resolved after soybean lipid emulsion (SLE) was removed from parenteral nutrition (PN) and enteral fish oil was given. Methods A retrospective review at a tertiary children's hospital (July 2003 to August 2008) identified 6 infants with intestinal failure requiring PN for >6 months who developed severe hepatic dysfunction that was managed by eliminating SLE and providing enteral fish oil. Results Twenty‐three infants with short bowel syndrome requiring prolonged PN developed cholestasis. SLE was removed in 6 of these patients, and 4 of the 6 received enteral fish oil. Standard PN included 2‐3 g/kg/d SLE with total PN calories ranging from 57 to 81 kcal/kg/d at the time of SLE removal. Hyperbilirubinemia resolved after elimination of SLE within 1.8‐5.4 months. Total PN calories required to maintain growth generally did not change. Conclusions Temporary elimination of SLE and supplementation with enteral fish oil improved cholestasis in PN‐dependent infants. Further trials are needed to evaluate this management strategy.