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NOTE LIST

Systematic Review 2013:

Potential benefits & harms of FOLE in pediatric 0-18yrs Seida, J etal JPEN 2013; 37:44-55

Goulet 2010

  • N=28
  • RCTs
  • SMOFvs Intralipid
  • Dose:1.4g/kg/d
  • Period:28 days
  • Enteral: ND
  • SBS on Home PN
  • Conclusions:
    • ↓TB,↑n3 & toco status

Skouroliako 2010

  • N=19
  • RCTs
  • SMOF vs Intralipid
  • Dose:~2.2g/kg/d
  • Period:41vs28days
  • Enteral: <20% TE
  • Prems
  • Conclusions:
    • ↓oxidative stress

Tomsits 2010

  • N=30
  • RCTs
  • SMOF vs Intralipid
  • Dose:1.6g/kg/d
  • Period:~11days
  • Enteral: <50% TE
  • Prems
  • Conclusions:
    • Potential benefit cholestasis

Rayyan 2012

  • N=53
  • RCTs
  • SMOF vs Intralipid
  • Dose:2.1g/kg/d
  • Period:7-14days
  • Enteral: <70% TE
  • Prems
  • Conclusion:
    • Improved fatty acid

Gura 2008

  • N=18 vs 21
  • Prospective cohort
  • Omegaven vs Soya
  • Dose:1g/kg/d
  • [control 4g/kg/day]
  • Period:14-23weeks
  • Enteral: ND
  • Prems with SBS & cholestasis
  • Conclusion:
    • May be effective cholestasis

 

Puder 2009

  • N=42vs49
  • Prospective cohort
  • Omegaven vs Soya
  • Dose:1g/kg/d [soya 1-4]
  • Period:7 weeks
  • Enteral:
  • Prem with SBS & cholestasis
  • Conclusion:
    • May be effective cholestasis, ↓MR & Tx



Pawlik 2011

  • N=40 vs 44
  • Prospective cohort
  • 1:1Clin+Omeg vs Clinoleic
  • Dose:3.5g/kg/d
  • Period:
  • Enteral:ND
  • Prem with LBW
  • Conclusion:
    • 1st day life may prevent ROP

Larsen 2012

  • N=36
  • RCTs
  • Lipoplus vs Intralipid
  • Dose:~19g/d
  • Period:14 days
  • Enteral: <30kcal/kg/day
  • Infants scheduled cardiac surgery
  • Conclusion:
    • ↓TNF, cytokines in infants heart surgery
  • 8 Studies reviewed the impact of Fish oil lipid emulsions
  • Outcomes: growth, liver functions, fatty acid status, mortality

Results:

5 RCTs studies:

  • 4 x SMOF compared with Intralipid
  • 1 x Lipoplus [SMF] compared with Intralipid
  • 3 x prems & 1 infant with congenital heart disease
  • 1 x home PN 5m-11years
  • Sample sizes of these studies were small [largest size 60 pts]

No difference – adverse events, sepsis, infection = all showed to be safe
No difference – growth parameters and biochemical parameters
One study showed – ↓TB and improved n3 & tocopherol status

Results:

3 x cohorts:

Prospective observational studies done PREMs

  • 2 x patients with cholestasis receiving Intralipid
  • Then given Omegaven – reduced lipid dose
  • The other study – omegaven+olive vs olive



Total bilirubin levels significantly improved with the use of Omegaven
No difference – the rate of liver Treatment and the mortality rate

 

Limitations:

  • The lipid dose varied
  • Timing and duration varied of administration of lipid emulsion

Conclusion:

  • Even though there was a lack of sufficient high quality data
  • The best available data supports the use of omega 3 fatty acids to improve biochemical outcomes in IFALD
  • Potential benefit in premature infants – improving Essential Fatty Acid status – neurocognitive