Is the use of parenteral ω-3 lipid emulsions justified in surgical neonates with mild parenteral nutrition–associated liver dysfunction?

A contemporary analysis of parenteral nutrition–associated liver disease in surgical infants

“…In fact, every subject in this long-term PN subgroup had developed cholestasis by 7 weeks of PN exposure. These data regarding the early time course for PN-associated liver disease are corroborated by a recent analysis of cholestasis in the neonatal population at a separate institution [22].…”

Novel Lipid-Based Approaches to Pediatric Intestinal Failure–Associated Liver Disease

“…This concern is further highlighted by a recent publication from our group showing that only 10% of infants receiving PN with a CB level of 2 mg/dL progressed to more advanced IFALD, defined as a serum CB level greater than 6.7 mg/ dL. 64 Therefore, should the threshold for initiation of a novel lipid-based approach be set at 2 mg/dL, as is already occurring at some centers, only 10% of surgical infants treated with a novel approach would be expected to benefit relative to conventional management.…”

ESPEN guideline on clinical nutrition in liver disease

“…In an analysis of 292 infants receiving more than one day of PN postoperatively, 31 infants reached a serum bilirubin >100 mmol/L and 13 developed liver failure, whereas 86 (83%) reaching a serum bilirubin >33 mmol/L could be weaned off PN [534]. The authors question the routine use of a fish-oil emulsion in such a population outside of formal research protocols.…”