The Indian Journal of Pediatrics

, Volume 86, Issue 6, pp 494–495 | Cite as

Fish Oil Based Lipid Emulsions for the Treatment of Intestinal Failure Associated Liver Disease: Nothing Fishy About it!

  • Rishi Bolia
  • Anshu SrivastavaEmail author
Editorial Commentary

Intestinal failure (IF) is a condition in which the gut is unable to provide adequate nutrient and fluid requirements for the maintenance of metabolic functions and growth in children. Long-term parenteral nutrition (PN) is the backbone of management, however it is complicated by intestinal failure associated liver disease (IFALD) in ~20% children [1]. IFALD is defined as hepatic dysfunction as a consequence of the medical and surgical management strategies for IF. Serum bilirubin is a marker of IFALD, value of >1.2 mg/dl is considered a “red flag” and > 5.8 mg/dl is suggestive of marked liver injury [1]. IFALD varies in severity from biochemical cholestasis to end stage liver disease requiring liver ± intestinal transplantation. Risk factors for IFALD include prematurity, lack of enteral nutrition, sepsis, longer duration and constituents of PN [1].

In this issue, Miura et al. report a premature infant with short bowel syndrome on PN who developed IFALD, which was successfully treated...


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Conflict of Interest



  1. 1.
    Lacaille F, Gupte G, Colomb V, et al. ESPGHAN Working Group of Intestinal Failure and Intestinal Transplantation. Intestinal failure-associated liver disease: a position paper of the ESPGHAN Working Group of Intestinal Failure and Intestinal Transplantation. J Pediatr Gastroenterol Nutr. 2015;60:272.Google Scholar
  2. 2.
    Miura W, Nagano N, Kato R, et al. Intestinal failure-associated liver disease and eicosapentaenoic acid/arachidonic acid ratio. Indian J Pediatr 2019 Feb 13. [Epub ahead of print].
  3. 3.
    Hojsak I, Colomb V, Braegger C, et al. ESPGHAN Committee on Nutrition. ESPGHAN Committee on Nutrition Position Paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2016;62:776.Google Scholar
  4. 4.
    Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis. J Nutr. 2015;145:277.CrossRefGoogle Scholar
  5. 5.
    Lam HS, Tam YH, Poon TC, et al. A double-blind randomised controlled trial of fish oil-based versus soy-based lipid preparations in the treatment of infants with parenteral nutrition-associated cholestasis. Neonatology. 2014;105:290.CrossRefGoogle Scholar
  6. 6.
    Wang C, Venick RS, Shew SB, et al. Long-term outcomes in children with intestinal failure-associated liver disease treated with 6 months of intravenous fish oil followed by resumption of intravenous soybean oil. J Parenter Enter Nutr. 2018 Nov 8. [Epub ahead of print].
  7. 7.
    Norsa L, Nicastro E, Di Giorgio A, Lacaille F, D'Antiga L. Prevention and treatment of intestinal failure-associated liver disease in children. Nutrients. 2018;10:664.CrossRefGoogle Scholar
  8. 8.
    Belza C, Thompson R, Somers GR, et al. Persistence of hepatic fibrosis in pediatric intestinal failure patients treated with intravenous fish oil lipid emulsion. J Pediatr Surg. 2017;52:795.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Division of Pediatric Gastroenterology, Department of GastroenterologyPGIMERChandigarhIndia
  2. 2.Department of Pediatric GastroenterologySGPGIMSLucknowIndia

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