Aims In infants with intestinal failure-associated liver disease (IFALD), it is known that episodes of sepsis can be accompanied by a significant deterioration in liver function. We hypothesised that an intravenous lipid emulsion (ILE) comprised solely of fish oil, high in omega-3 fatty acids, such as Omegaven®, may protect the liver in these infants during episodes of sepsis. Our aim is to describe the potential role for Omegaven® as a rescue therapy in infants with sepsis and established IFALD.
Methods A mixed source ILE containing both omega-3 and omega-6 fatty acids (SMOFlipid®) was used as first-line in infants at high risk of IFALD. When infants with IFALD developed sepsis, Omegaven® was used as the sole ILE for up to 14 days. A retrospective review of their case notes was conducted.
Results Omegaven® was well tolerated in all infants. 7 infants had Omegaven® treatment during a 14-month period (August 2011-October 2012). Median birth weight was 1000g (range 527–1870). Median gestation at birth was 30 weeks (range 24–34). Of the 7 patients, 2 had gastrochisis and 5 had necrotising enterocolitis (NEC). One patient with gastrochisis developed NEC. 2 patients were late transfers at 4–5 months of age from other hospitals with severe and progressive IFALD. Both subsequently died. Median age at start of Omegaven® was 63 days (range 7–189). 3 patients did not complete the full 2-week course of Omegaven®. All had total bilirubin levels above 80μmol/l at commencement of Omegaven®. During their episodes of sepsis, bilirubin and CRP rose in all patients. Transaminases were deranged in all. All 7 patients showed improvement in septic markers during Omegaven® treatment. 3 patients showed improvement in bilirubin during treatment, which was maintained in the long term in 2. 1 patient was transferred to another centre for further medical treatment early in her Omegaven® course: her bilirubin was static.
Conclusion Use of Omegaven® as a short term rescue ILE in infants with IFALD and sepsis appears safe. The expected deterioration in liver function associated with sepsis was not seen in this series.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.