Raphael BP, Mitchell PD, Gura KM, Potemkin AK, Squires RH, Puder M, Duggan CP. Growth in Infants and Children with Intestinal Failure Associated-Liver Disease Treated with Intravenous Fish Oil. J Pediatr Gastroenterol Nutr. 2019 Nov 6. doi: 10.1097/MPG.0000000000002551. PubMed PMID: 31703040.
BACKGROUND: Infants with intestinal failure (IF) and IF-associated-liver disease (IFALD) are at risk for poor somatic growth due to increased metabolic demands, inadequate intake, intestinal malabsorption, chronic liver disease and other co-morbidities. There are limited data on the nutritional adequacy of intravenous fish oil lipid emulsion (FOLE) compared with standard soybean oil lipid emulsion (SOLE) in the setting of intestinal failure.
AIMS: To describe growth patterns in a large cohort of infants with IFALD treated with FOLE.
METHODS: We compared growth data from infants enrolled in a single center, prospective FOLE study to published norms, as well as to a multicenter, historical cohort of infants with IF treated with SOLE.
RESULTS: 138 infants with IFALD were treated with FOLE and 108 with SOLE. Compared to normative growth curves from WHO and published pre-term data, infants in both groups from 6 to 11 months post-menstrual age exhibited declines in mean weight- and length-for-age Z-scores. At 24 months post-menstrual age compared with WHO growth data, infants treated with FOLE had a mean (95% confidence interval) weight-for-age Z-score of 0.13 (-0.18, 0.45) and length-for-age Z-score of 0.07 (-0.33, 0.47). In comparison, at 24 months post-menstrual age, infants treated with SOLE had a mean weight for age Z-score of -0.93 (-1.20, -0.67) and mean length for age Z-score of -2.33 (-2.75, -1.91). Independent predictors of higher weight, length and head circumference Z-scores included older post-menstrual age at baseline, fewer central line-associated blood stream infections, resolution of cholestasis, type of intravenous fat emulsion (FOLE vs. SOLE) and female sex.
CONCLUSIONS: Infants with IFALD treated with FOLE showed comparable somatic growth to those treated with SOLE in early infancy, and improved somatic growth up to 24 months of age, supporting its wider use in this patient population.
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