Intravenous Fish Oil and Serum Fatty Acid Profiles in Pediatric Patients With Intestinal Failure–Associated Liver Disease

Abstract

Background: Intravenous fish oil (FO) treats pediatric intestinal failure associated liver disease (IFALD). There are concerns that a lipid emulsion composed of omega-3 fatty acids will cause an essential fatty acid deficiency (EFAD). This study’s objective was to quantify the risk for abnormal fatty acid concentrations in children treated with FO. Methods: Inclusion criteria for this prospective study was children with intestinal failure. Intravenous soybean oil (SO) was replaced with FO for no longer than 6 months. Serum fatty acids were analyzed using linear and logistic models, and compared to age-based norms to determine the percentage of subjects with low and high concentrations. Results: Subjects (n=17) started receiving FO at a median of 3.6 months of age (IQR 2.4-9.6 months). Over time, α-linolenic, linoleic, arachidonic and Mead acid decreased, while docosahexaenoic and eicosapentanoic acid increased (p<0.001 for all). Triene:tetraene ratios remained unchanged (p=1). Although subjects were 1.8 times more likely to develop a low linoleic acid while receiving FO vs. SO (95% CI 1.4-2.3, p<0.01), there was not a significant risk for low arachidonic acid. Subjects were 1.6 times more likely to develop high docosahexaenoic acid while receiving FO vs. SO; however this was not significant (95% CI 0.9-2.6, p=0.08). Conclusion: In this cohort of parenteral nutrition-dependent children, switching from SO to FO led to a decrease in essential fatty acid concentrations, but an EFAD was not evident. Low and high levels of fatty acids developed. Further investigation is needed to clarify if this is clinically significant. Trial Identifier:

Use of Fish Oil Intravenous Lipid Emulsions as Monotherapy in the Pediatric Intestinal Failure Patient: Beyond the Package Insert

“…Similar studies have confirmed these findings . This confirms that these patients did not develop EFAD, as they did not produce extra non‐EFAs to compensate for a decrease in ALA and LA concentrations …”

Significant Published Articles for Pharmacy Nutrition Support Practice in 2019

“…An additional 2 papers were voted as important by a majority of the authors which allowed for a total of 6 papers to be identified for further evaluation. [7][8][9][10][11][12] An additional 9 articles comprising organizational guidelines, consensus, recommendation, and position papers included separately as important papers to our practice. [13][14][15][16][17][18][19][20][21] Of these 15 finalist articles, 6 were published in Journal of Parenteral and Enteral Nutrition, 6 in Clinical Nutrition, 2 in Journal of Trauma and Acute Care Surgery, and 1 in Nutrition in Clinical Practice.…”

“…Osowska et al 12 Effect of changing the lipid component of home parenteral nutrition in adults 5 Hartl et al 7 Calorie intake and short-term survival of critically ill patients 4* Ong et al 11 Intravenous Fish Oil and Serum Fatty Acid Profiles in Pediatric Patients with Intestinal Failure-Associated Liver Disease…”

ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations

“…There have been reports of FO‐ILE doses of up to 1.5 g/kg/day when additional calories are necessary and unable to be provided by higher dextrose loads 51 . Although FO contains minimal ALA and LA, patients receiving FO‐ILE at recommended doses have not developed clinical EFAD, because of DHA and EPA content within FO‐ILE 58 …”