The impact of intravenous fish oil emulsions on pediatric intestinal failure-associated liver disease.

PURPOSE OF REVIEW: To provide an overview of how intravenous omega-3 fatty acids (O3FAs) have been used to prevent and treat pediatric intestinal failure-associated liver disease (IFALD). This review will introduce the most recent and relevant human and basic science data on the topic, and comment on how alterative lipid emulsions may alter the future course of children with IFALD.

RECENT FINDINGS: Animal and cohort studies along with case reports have reported that Omegaven (Fresenius Kabi, Bad Homburg vdh, Germany), which contains high concentrations of O3FAs, can reverse IFALD and prevent the need for combined liver-intestinal transplantation and death. Laboratory work and human data support that O3FAs increase antioxidant activity and biliary flow and decrease inflammation and de-novo lipogenesis. Many postulate that intravenous O3FAs may positively affect cognitive function, immune status, nutrition, and intestinal adaptation and decrease the risk of adult-onset chronic diseases. Although evidence continues to mount to support the use of parenteral O3FA products, questions remain.

SUMMARY: O3FAs have altered the way in which basic scientists and clinicians approach IFALD. Knowledge gaps, however, still exist before this therapy can be considered standard of care.