Favorable Outcomes of Preterm Infants With Parenteral Nutrition-associated Liver Disease Treated With Intravenous Fish Oil-based Lipid Emulsion
Favorable Outcomes of Preterm Infants With Parenteral Nutrition-associated Liver Disease Treated With Intravenous Fish Oil-based Lipid Emulsion
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DOI：
10.1097/mpg.0000000000001397
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发表时间：
2017-05-01
影响因子：
2.9
通讯作者：
Blanco, Cynthia
中科院分区：
文献类型：
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作者：
Sorrell, Michael;Moreira, Alvaro;Blanco, Cynthia
目的：本研究的目的是确定静脉注射鱼油脂肪乳剂（FishLE）治疗肠外营养相关性肝病（PNALD）的早产儿的急性和长期结局。方法：14天至24个月龄的早产儿，解剖短肠或严重肠动力障碍，血清直接胆红素>= 4 mg/dL，并且需要肠外营养>60%热量的患者是合格的。入组婴儿接受1 g.kg（-1）。第（-1）天FishLE，直至直接高胆红素血症消退或恢复肠内营养。监测急性临床效应和肝功能生化指标。在6个月和12个月月经后的年龄（PMA）的生长发育评分进行了评估，并与对照组相匹配的胎龄（GA）。结果：13例患者的平均GA为28 +/- 4周进行了治疗，并与119 GA匹配的对照组进行了比较。入组时平均直接胆红素为9.8 +/- 6.4 mg/dL。研究完成后，所有婴儿的胆汁淤积均消退。无急性不良事件、死亡或肝/肠移植。在6个月和12个月PMA时，FishLE治疗患者和对照组的体重和头围相似。FishLE治疗的婴儿在PMA 6个月和12个月时认知和运动评分下降。Logistic回归分析表明，住院时间延长是有害的认知和运动发育，而治疗not.Conclusions：静脉内FishLEs在早产儿中的使用似乎是安全的，逆转PNALD，尽管显着的肝脏疾病和肠功能衰竭。这种疗法应用于患有PNALD的早产儿，并长期随访以评估发育。
Objectives: The aim of the study was to determine the acute and long-term outcomes of preterm infants treated with an intravenous fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD).Methods: Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin >= 4 mg/dL, and requiring >60% calories from parenteral nutrition were eligible. Enrolled infants received 1 g.kg(-1) . day(-1) of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition. Acute clinical effects and biochemical markers of liver function were monitored. Growth and developmental scores at 6 and 12 months postmenstrual age (PMA) were assessed and compared with controls matched by gestational age (GA).Results: Thirteen patients with mean GA of 28 +/- 4 weeks were treated and compared with 119 GA-matched controls. Their mean direct bilirubin was 9.8 +/- 6.4 mg/dL at enrollment. All infants had resolution of cholestasis after study completion. There were no acute adverse events, deaths, or liver/intestinal transplants. Weight and head circumference were similar between FishLE-treated patients and controls at 6- and 12-month PMA. Cognitive and motor scores were decreased at 6 and 12 months PMA in FishLE-treated infants. Logistic regression analysis showed that prolonged hospitalization was detrimental to cognitive and motor development, whereas treatment was not.Conclusions: The use of intravenous FishLEs in premature infants appears to be safe and reverses PNALD despite significant liver disease and intestinal failure. This therapy should be used in preterm infants with PNALD and followed long term to evaluate development.