Kara L Calkins1, James C Y Dunn2, Stephen B Shew2, Laurie Reyen3, Douglas G Farmer4, Sherin U Devaskar5, Robert S Venick6. 1. Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center KCalkins@mednet.ucla.edu. 2. Department of Surgery, Division of Pediatric Surgery. 3. Department of Nursing. 4. Department of Surgery. 5. Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center. 6. Department of Surgery Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine, Mattel Children's Hospital UCLA, University of California, Los Angeles.
Abstract
BACKGROUND: Studies have suggested that when intravenous (IV) soybean oil (SO) is replaced with fish oil (FO), direct hyperbilirubinemia is more likely to resolve. The necessary duration of FO has not been established. This study seeks to determine if 24 weeks of FO is an effective and safe therapy for intestinal failure-associated liver disease (IFALD). MATERIALS AND METHODS: This is a clinical trial using patients with IFALD between the ages of 2 weeks and 18 years. SO was replaced with FO (1 g/kg/d) in 10 patients who were receiving most of their calories from parenteral nutrition (PN). Patients were compared with 20 historic controls receiving SO. SO for both groups was prescribed by the primary medical team at variable doses. The primary outcome was time to reversal of cholestasis. Secondary outcomes were death, transplant, and full enteral feeds. Safety measurements included growth, essential fatty acid deficiency, and laboratory markers to assess bleeding risk. RESULTS: The Kaplan-Meier method estimated that 75% in the FO group would experience resolution of cholestasis by 17 weeks vs 6% in the SO group (P < .0001). When compared with the SO group, the FO group had decreased serum direct bilirubin concentrations at weeks 8 (P = .03) and 12, 16, 20, and 24 weeks (P < .0001). Although length z score at the end of the study increased in the FO group compared with baseline (P = .03), there were no significant differences in other outcomes. CONCLUSIONS: A limited duration of FO appears to be safe and effective in reversing IFALD.
BACKGROUND: Studies have suggested that when intravenous (IV) soybean oil (SO) is replaced with fish oil (FO), direct hyperbilirubinemia is more likely to resolve. The necessary duration of FO has not been established. This study seeks to determine if 24 weeks of FO is an effective and safe therapy for intestinal failure-associated liver disease (IFALD). MATERIALS AND METHODS: This is a clinical trial using patients with IFALD between the ages of 2 weeks and 18 years. SO was replaced with FO (1 g/kg/d) in 10 patients who were receiving most of their calories from parenteral nutrition (PN). Patients were compared with 20 historic controls receiving SO. SO for both groups was prescribed by the primary medical team at variable doses. The primary outcome was time to reversal of cholestasis. Secondary outcomes were death, transplant, and full enteral feeds. Safety measurements included growth, essential fatty acid deficiency, and laboratory markers to assess bleeding risk. RESULTS: The Kaplan-Meier method estimated that 75% in the FO group would experience resolution of cholestasis by 17 weeks vs 6% in the SO group (P < .0001). When compared with the SO group, the FO group had decreased serum direct bilirubin concentrations at weeks 8 (P = .03) and 12, 16, 20, and 24 weeks (P < .0001). Although length z score at the end of the study increased in the FO group compared with baseline (P = .03), there were no significant differences in other outcomes. CONCLUSIONS: A limited duration of FO appears to be safe and effective in reversing IFALD.
Authors: Rafeeq Muhammed; Ronald Bremner; Sue Protheroe; Tracey Johnson; Chris Holden; M Stephen Murphy Journal: J Pediatr Gastroenterol Nutr Date: 2012-06 Impact factor: 2.839
Authors: Daniel T Robinson; Susan E Carlson; Karna Murthy; Brandy Frost; Shengqi Li; Michael Caplan Journal: J Pediatr Date: 2012-08-09 Impact factor: 4.406
Authors: Mary Petrea Cober; Ghassan Killu; Allison Brattain; Kathleen B Welch; Shaun M Kunisaki; Daniel H Teitelbaum Journal: J Pediatr Date: 2011-10-06 Impact factor: 4.406
Authors: Annika Kurvinen; Markku J Nissinen; Sture Andersson; Päivi Korhonen; Tarja Ruuska; Mari Taimisto; Marko Kalliomäki; Liisa Lehtonen; Ulla Sankilampi; Pekka Arikoski; Timo Saarela; Tatu A Miettinen; Helena Gylling; Mikko P Pakarinen Journal: J Pediatr Gastroenterol Nutr Date: 2012-06 Impact factor: 2.839
Authors: Richard A Ehrenkranz; Anna M Dusick; Betty R Vohr; Linda L Wright; Lisa A Wrage; W Kenneth Poole Journal: Pediatrics Date: 2006-04 Impact factor: 7.124
Authors: Kara Calkins; Allison Lowe; Stephen B Shew; James C Y Dunn; Laurie Reyen; Douglas G Farmer; Sherin U Devaskar; Robert Venick Journal: J Pediatr Surg Date: 2013-01 Impact factor: 2.545
Authors: David F Mercer; Brandy D Hobson; Ryan T Fischer; Geoffrey A Talmon; Deborah A Perry; Brandi K Gerhardt; Wendy J Grant; Jean F Botha; Alan N Langnas; Ruben E Quiros-Tejeira Journal: J Pediatr Gastroenterol Nutr Date: 2013-04 Impact factor: 2.839
Authors: Robert H Squires; Christopher Duggan; Daniel H Teitelbaum; Paul W Wales; Jane Balint; Robert Venick; Susan Rhee; Debra Sudan; David Mercer; J Andres Martinez; Beth A Carter; Jason Soden; Simon Horslen; Jeffrey A Rudolph; Samuel Kocoshis; Riccardo Superina; Sharon Lawlor; Tamara Haller; Marcia Kurs-Lasky; Steven H Belle Journal: J Pediatr Date: 2012-05-11 Impact factor: 4.406
Authors: Mathias Plauth; William Bernal; Srinivasan Dasarathy; Manuela Merli; Lindsay D Plank; Tatjana Schütz; Stephan C Bischoff Journal: Clin Nutr Date: 2019-01-16 Impact factor: 7.324
Authors: Caroline Wang; Robert S Venick; Stephen B Shew; James C Y Dunn; Laurie Reyen; Rong Gou; Kara L Calkins Journal: JPEN J Parenter Enteral Nutr Date: 2018-11-08 Impact factor: 4.016
Authors: Sarah J Carlson; Prathima Nandivada; Melissa I Chang; Paul D Mitchell; Alison O'Loughlin; Eileen Cowan; Kathleen M Gura; Vania Nose; Bruce R Bistrian; Mark Puder Journal: Metabolism Date: 2014-10-13 Impact factor: 8.694
Authors: Kara L Calkins; Thomas Havranek; Lorraine I Kelley-Quon; Laura Cerny; Martiniano Flores; Tristan Grogan; Stephen B Shew Journal: JPEN J Parenter Enteral Nutr Date: 2016-07-11 Impact factor: 4.016