Neonatal growth with fish oil or mixed oil lipid emulsions in intestinal failure associated liver disease

Background Treatment strategies for intestinal failure associated liver disease (IFALD) include use of fish-oil lipid emulsion (FO-ILE) or mixed-oil emulsion containing soy, medium chain triglyceride, olive, and fish oils (SO,MCT,OO,FO-ILE). FO-ILE is limited to 1 g/kg/day, either limiting overall calorie provision or shifting calories toward carbohydrate predominance. The objective of this project was to compare the growth of neonates with IFALD receiving either SO,MCT,OO,FO-ILE or FO-ILE. Material and methods A retrospective chart review was conducted of neonates with IFALD receiving SO,MCT,OO,FO-ILE or FO-ILE. Growth metrics, nutritional data, and lab values were analyzed using the Mann-Whitney or t-test with a p-value < 0.05 used for significance. Results We included 46 patients (22 SO,MCT,OO,FO-ILE; 24 FO-ILE). Both groups had similar weight gain (SO,MCT,OO,FO-ILE 24.6 vs FO-ILE 31.6 g/day; p = 0.121), although the FO-ILE patients had increased weight z-scores over time (SO,MCT,OO,FO-ILE: −0.11 vs FO-ILE: 0.09 p = 0.032). The FO-ILE group received fewer calories (SO,MCT,OO,FO-ILE:112 vs FO-ILE:100.7 kcal/kg/day; p = 0.004), less lipid (SO,MCT,OO,FO-ILE: 2.1 vs FO-ILE 1.0 g/kg/day; p < 0.001), and more carbohydrate (SO,MCT,OO,FO-ILE: 9.6 vs FO-ILE: 12.8 mg/kg/min; p < 0.001). Conclusion Neonates receiving FO-ILE had similar weight gain to those receiving SO,MCT,OO,FO-ILE while receiving fewer overall calories and parenteral lipid. The FO-ILE group did have increased weight z-score over time. Further investigation is needed to understand the influence of these differences on additional short-term and long-term outcomes.