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NOTE LIST

Fish Oil Lipid Emulsions (FOLE) in PNAC

  • Fish oils are high in omega 3s
    • They are responsible for the down regulation of inflammation mediators
  • Having the ideal ratio of n6:n3 is an important marker in the regulation of inflammatory mediators
  • There are likely 3 main mechanisms:
    • Improving bile flow
    • Decreasing steatosis
    • Immunomodulatory response

EVIDENCE for the use of FOLE in PNAC

  • 18 infants with Short Bowel Syndrome who developed cholestasis while on Soya LE
  • Historical cohort receiving Soya [n=21]
  • Primary outcome: reversal of cholestasis [TB<2mg/dL]
  • Fish oil was 1g/kg/day [12 hours]
  • Soya group: 1-4g/kg [24 hours]
  • Period: median time of 18 weeks

Results:

  • Median time to reversal : 9.4 weeks vs 44.1 weeks in control
  • Transplantation: 0 in fish oil vs 2 in soya
  • Deaths: 2 in fish oil vs 7 in soya
  • No association with Essential Fatty Acid Deficiency, Hypertriglycerideamia, coagulopathy, infections or growth delay when given fish oil

Limitations or concerns from fish oil as a monotherapy:

  1. Low dose of lipid – 1g/kg/d
    • Lower dose of benefit or type of lipid
  2. Long term effects
    • Fatty acid deficiency
  3. Growth restriction
    • Low lipid dose
    • And both n6 and n3 needed for growth

Therefore more than one lipid that includes soya is recommendedÂ