Fish oil emulsion for reversal of intestinal failure-associated liver disease in preterm infants: Three case reports and review of literature

Table 1 Clinical characteristics of 3 cases

		Case 1	Case 2	Case 3
Sex		Male	Female	Male
Gestational age		31 weeks	35 weeks	36+2 weeks
Birth weight		1320 g	920 g	2750 g
Condition		Necrotizing enterocolitis, septic shock, meconium intestinal obstruction	Hemodynamically significant patent ductus arteriosus, heart failure, neonatal pneumonia	Complex small bowel atresia, neonatal sepsis
Medications that may cause cholestasis		Cefoperazone-sulbactam, vancomycin	Cefoperazone-sulbactam, meropenem, ibuprofen	Cefoperazone-sulbactam, meropenem
Direct bilirubin (μmol/L)	At FO-ILE start	229.2	191.9	38.4
	Peak value	229.2	191.9	356
	At FO-ILE cessation	89.9	19.9	30.7
Peak total bilirubin (μmol/L)		300.9	298.3	451.9
Duration of PN before FO-ILE		69 days	22 days	42 days
Duration of FO-ILE therapy		29 days	47 days	63 days
Duration of PN after FO-ILE		0 days	0 days	0 days
Duration of PN		98 days	69 days	105 days
Peak triglyceride level (borderline high: 1.7-2.25 mmol/L)		2.00 mmol/L	2.06 mmol/L	3.39 mmol/L
Peak prothrombin time value (9.0-15.0 seconds)		14.7 seconds	15.7 seconds	16.5 seconds
Peak APTT value (18.3-38.3 seconds)		45.9 seconds	48.3 seconds	37.2 seconds
Peak INR value (0.8-1.5)		1.43	1.53	1.65
Triene:Tetraene		Normal	Normal	Normal
Outcome		Resolved	Resolved	Resolved

FO-ILE: Fish oil lipid emulsion; PN: Parenteral nutrition; APTT: Activated partial thromboplastin time; INR: International normalized ratio.

Table 2 Comparison of direct bilirubin reduction rates from start to end of fish oil therapy at 1 g/kg/day vs 2 g/kg/day

Cases	DB at fish oil initiation (μmol/L)	DB at fish oil cessation (μmol/L)	Duration of fish oil therapy	DB reduction rates (μmol/L/day)
This Case 1	229.2	89.9	29 days	4.80
This Case 2	191.9	19.9	47 days	3.66
Case 2[20]	44.5	23.9	27 days	0.76
Case 4[20]	51.3	22.2	39 days	0.75
Case 5[20]	70.1	41.0	33 days	0.88
Case 7[20]	148.8	22.2	54 days	2.34
Case 8[20]	162.5	12.0	57 days	2.64
Case 9[20]	160.7	25.7	82 days	1.65
Case 10[20]	109.4	17.1	59 days	1.56
Case 11[20]	90.6	85.5	26 days	0.20
Case 12[20]	198.4	112.9	112 days	0.76
Case 13[20]	212.0	159.0	38 days	1.39
Case 1[50]	58.1	23.9	90 days	0.38
Case 2[50]	99.2	32.5	21 weeks	0.45
Case 1[51]	186.4	1.7	41 weeks	0.64
Case 2[51]	59.9	22.2	5 weeks	1.08
Case 3[51]	70.1	1.7	12 weeks	0.81
Case 4[51]	46.2	1.7	17 weeks	0.31
Case 6[51]	42.8	1.7	16 weeks	0.37
Case 7[51]	42.8	5.1	40 weeks	0.13
Case 8[51]	145.4	41.0	32 weeks	0.47
Case 10[51]	167.6	95.8	13 weeks	0.79

DB: Direct bilirubin.

Table 3 Comparison of the direct bilirubin reduction rates from peak direct bilirubin values to end of treatment at fish oil doses of 1 g/kg/day vs 2 g/kg/day

Cases	Peak DB (μmol/L)	DB at fish oil cessation (μmol/L)	Duration of fish oil therapy from peak	DB reduction rate (μmol/L/day)
This Case 1	229.2	89.9	29 days	4.80
This Case 2	191.9	19.9	47 days	3.66
This Case 3	356	30.7	33 days	9.86
Case 1[50]	109.4	23.9	90 days	0.95
Case 2[50]	136.8	32.5	16 weeks	0.93
Case 5[51]	212.0	10.3	14 weeks	2.06

DB: Direct bilirubin.