Is the use of parenteral ω-3 lipid emulsions justified in surgical neonates with mild parenteral nutrition–associated liver dysfunction?

PurposeAlthough evidence suggests that parenteral ω-3 lipid emulsions (O-3LEs) may be beneficial in treating advanced parenteral nutrition (PN)–associated liver disease, our objective was to determine if O-3LEs are justified in those with early liver disease.MethodsThis is a retrospective analysis of prospectively collected data on all surgical neonates, who received more than 1 day of PN postoperatively between 2001 and 2004 with observation through 2005 (era before O-3LE introduction). We examined the proportion of those who developed mild and advanced liver dysfunction.ResultsOf the 292 infants in the cohort, 104 (36%) developed mild liver dysfunction (conjugated bilirubin, 34 μmol/L [cBili34]) after a mean of 22 days. Thirty-one (30%) of the cBili34 patients reached a serum conjugated bilirubin of 100 μmol/L, and 13 (13%) developed liver failure. Of these, 4 underwent transplantation, and 5 died of hepatic disease. Overall, 86 of the cBili34 patients (83%) were weaned off PN.ConclusionWith more than 80% of cBili34 patients being weaned from PN without adverse hepatic sequelae, it is difficult, in the absence of definitive evidence of efficacy and safety for O-3LEs together with increased costs, to justify the routine use of O-3LEs in this low-risk population outside formal research protocols.