Lee Sanghoon, Sung Se In, Park Hyo Jung, Chang Yun Sil, Park Won Soon, Seo Jeong-Meen
Intestinal Rehabilitation Team, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
J Clin Med. 2020 Oct 23;9(11):3393. doi: 10.3390/jcm9113393.
Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center's nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.
肠衰竭相关肝病（IFALD）是肠外营养（PN）的一种危及生命的并发症，在接受长期PN的早产新生儿群体中最为常见。在本研究中，我们报告了在给予早产低体重儿的基于鱼油的复合脂质乳剂中，使用鱼油单一疗法治疗IFALD的经验结果。空腹新生儿按照我们中心的营养方案给予PN。当血清直接胆红素水平在间隔超过一周的两次连续测量中>2.0mg/dL，且无肝功能障碍内在原因的证据时，诊断为IFALD。IFALD的治疗是通过将脂质乳剂从复合脂质乳剂转换为1.0g/kg/天的鱼油单一疗法，在24小时内输注。15名婴儿符合IFALD标准并接受了鱼油单一疗法。中位胎龄为27.5周，中位出生体重为862.5g。11名婴儿（11/15，73.3%）的IFALD成功逆转。鱼油单一疗法的中位持续时间为39天。直接胆红素值最初升高，然后从治疗第三周起稳步下降。治疗期间肠内耐受性不同程度增加。鱼油单一疗法期间平均体重增加为26.0g/天。剂量为1.0g/kg/天的Omegaven（奥地利格拉茨费森尤斯卡比公司）耐受性良好，未观察到与使用Omegaven相关的不良事件。在含鱼油的复合脂质乳剂上的早产婴儿通过转换为鱼油单一疗法实现了IFALD的逆转。
