Enteral Fish Oil for Treatment of Parenteral Nutrition‐Associated Liver Disease in Six Infants with Short‐Bowel Syndrome

• Published in: Pharmacotherapy Vol. 31; no. 5; pp. 503 - 509
• Main Authors: Tillman, Emma M., Crill, Catherine M., Black, Dennis D., Hak, Emily B., Lazar, Linda F., Christensen, Michael L., Huang, Eunice Y., Helms, Richard A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2011; Pharmacotherapy; Wiley Subscription Services, Inc
• Subjects: Bilirubin - blood; Biological and medical sciences; Dietary Supplements; enteral fish oil; Enteral Nutrition; Female; Fish Oils - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - surgery; infants; Intestinal Diseases - surgery; Liver Diseases - blood; Liver Diseases - diet therapy; Male; Medical sciences; nutrition; Other diseases. Semiology; Parenteral Nutrition - adverse effects; parenteral nutrition‐associated liver disease; Pharmacology. Drug treatments; PNALD; Remission Induction; Retrospective Studies; SBS; Short Bowel Syndrome - physiopathology; Short Bowel Syndrome - therapy; short‐bowel syndrome; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; infants; SBS; Infant; Hepatic disease; Parenteral nutrition; Short bowel syndrome; Fish oil; Parenteral administration; PNALD; nutrition; Treatment; Intestinal malabsorption; parenteral nutrition-associated liver disease; enteral fish oil; Digestive diseases; Intestinal disease; short-bowel syndrome
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.31.5.503

Study Objective. To evaluate the use of enteral fish oil for the treatment of parenteral nutrition‐associated liver disease (PNALD).
Design. Retrospective case series.
Setting. Pediatric academic hospital and outpatient clinic.
Patients. Six parenteral nutrition‐dependent infants with short‐bowel syndrome and PNALD.
Measurements and Main Results. The six infants received supplementation with enteral fish oil, and treatment was evaluated over a 12‐week period. The PNALD, as reflected by elevated total bilirubin levels, completely reversed in four of the six infants within a mean ± SD of 5 ± 2.6 weeks (range 2–8 wks) after initiation of the enteral fish oil supplementation. In addition, improvement in enteral feedings occurred after starting enteral fish oil therapy.
Conclusion. Enteral fish oil may be an effective adjunctive treatment option for infants with PNALD, particularly for those infants with PNALD who are tolerating some amount of enteral nutrition as the result of an adequate amount of small bowel.