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World J Clin Cases. Jul 26, 2026; 14(21): 123291
Published online Jul 26, 2026. doi: 10.12998/wjcc.123291
Fish oil emulsion for reversal of intestinal failure-associated liver disease in preterm infants: Three case reports and review of literature
Hong-Ju Chen, Zhuo-Ga Danzeng, Peng-Fei Ye, Xiao-Ming Xu, Juan Liang, Li Zhang
Hong-Ju Chen, Xiao-Ming Xu, Juan Liang, Li Zhang, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Hong-Ju Chen, Zhuo-Ga Danzeng, Xizang Region Child Development Clinical Medical Research Center, Xizang Hospital of West China Second University Hospital, Sichuan University & Xizang Autonomous Region Women’s and Children’s Hospital, Lhasa 850000, Xizang Autonomous Region, China
Hong-Ju Chen, Peng-Fei Ye, Xiao-Ming Xu, Juan Liang, Li Zhang, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Hong-Ju Chen, Zhuo-Ga Danzeng, Department of Neonatology, Xizang Hospital of West China Second University Hospital, Sichuan University & Xizang Autonomous Region Women’s and Children’s Hospital, Lhasa 850000, Xizang Autonomous Region, China
Peng-Fei Ye, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Co-corresponding authors: Juan Liang and Li Zhang.
Author contributions: Chen HJ, Liang J, and Zhang L conceptualized and designed this case analysis; Chen HJ, Danzeng ZG, and Xu XM drafted the initial manuscript; Chen HJ was responsible for defining the core issues and analyzing the case data; Danzeng ZG coordinated the writing process; Chen HJ, Danzeng ZG, and Ye PF contributed to the initial collection and organization of the case data; Liang J and Zhang L served as corresponding authors, ensuring the academic rigor and depth of the case analysis, taking primary responsibility for academic supervision, leading responses to reviewer comments, and guiding further improvements to the manuscript, thereby ensuring its academic quality and compliance with publication standards. All authors reviewed and approved the final version.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Supported by Clinical Research Funding of West China Second University Hospital, Sichuan University, No. KL073; and National Natural Science Foundation of China, No. 81501304.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Juan Liang, PhD, Department of Pediatrics, West China Second Univer
sity Hospital, Sichuan University, No. 20 Section 3, Renmin South Road, Wuhou District, Chengdu 610041, Sichuan Province, China.
liangjuan079@163.com
Received: May 14, 2026
Revised: June 3, 2026
Accepted: June 26, 2026
Published online: July 26, 2026
Processing time: 68 Days and 21.7 Hours
BACKGROUND
Prolonged parenteral nutrition (PN) is a major risk factor for intestinal failure-associated liver disease (IFALD), particularly in preterm infants. Plant-derived lipid emulsions, rich in phytosterols and ω-6 fatty acids, are considered key contributors. Fish oil lipid emulsions (FO-ILE) have emerged as a potential therapeutic alternative; however, the optimal dose for balancing efficacy and safety remains uncertain.
CASE SUMMARY
We report three preterm infants (gestational age, 31-36+2 weeks) with severe IFALD who were transitioned from soybean oil-based or multi-oil emulsions to FO-ILE. Fish oil was administered at a dose of 2 g/kg/day, a dosing approach for which limited data are available in this population. Prior to the transition, peak direct bilirubin (DB) levels ranged from 191.9 μmol/L to 356 μmol/L, with one patient exhibiting severe cholestasis and marked hepatosplenomegaly. Following 29-63 days of treatment, DB levels decreased to 30.7-89.9 μmol/L, resulting in a faster DB decline than that observed with the conventional 1 g/kg/day dosage. Full enteral feeding was achieved after 69-105 days of PN. The regimen was well tolerated, with no evidence of essential fatty acid deficiency, growth impairment, or bleeding complications.
CONCLUSION
FO-ILE up to 2 g/kg/day was well tolerated and improved liver function, which supports further investigation in PN-dependent infants.
Core Tip: Prolonged parenteral nutrition in preterm infants can lead to intestinal failure-associated liver disease (IFALD). We describe three preterm infants with severe IFALD who were treated with pure fish oil lipid emulsion (FO-ILE) at 2 g/kg/day—higher than conventional protocols. This approach was associated with a rapid decline in direct bilirubin levels and was well tolerated without evidence of essential fatty acid deficiency, growth impairment, or bleeding complications. To the best of our knowledge, this report is among the first reports of high-dose FO-ILE for severe IFALD in preterm infants, a vulnerable population because of hepatic immaturity.
