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2010 Annual Meeting Abstracts

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Enteral omega-3 supplementation for Short Bowel Syndrome management abrogates parenteral nutrition-associated cholestasis.
*Michele L Lombardo, Thomas F Tracy, Christopher S Muratore
Brown University, Providence, RI

Objective: In patients with short bowel syndrome (SBS), delayed bowel adaptation necessitates long-term parenteral nutrition (PN) with the inherent risk of PN associated cholestasis (PNAC). PNAC is thought to improve only once full enteral feeds are achieved and PN is discontinued. Recently, reversal of PNAC has been reported with the use of parenteral fish oil-based lipid emulsion. There limited data on the use of enteral fish oil supplements in PN-dependent populations. We present our strategy with enteral omega-3 supplementation of PN dependence in a pediatric patient with SBS.
Design: Case series
Setting: Academic medical center
Patients: Pediatric patient with short bowel syndrome as a result of severe necrotizing enterocolitis
Intervention: Our patient received Lovaza® (GlaxoSmithKline) omega-3-acid ethyl esters at 1g/kg/day in addition to parenteral nutrition and Intralipid® (Baxter Healthcare Corporation) at 1g/kg/day.
Main outcome measures: Weekly laboratory parameters were measured, including bilirubin levels and transaminases. Prealbumin and C-reactive protein were evaluated as a measure of hepatic homeostasis. Additionally, a comprehensive fatty acid profile to evaluate docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) was obtained during the course of treatment.
Results: Resolution of PNAC, (normalization of bilirubin levels) was demonstrated after seven weeks of enteral omega-3 supplementation. Prealbumin levels increased and C-reactive protein levels decreased while on full PN, with only minimal enteral feeds tolerated. DHA and EPA levels verified absorption of enteral omega-3 fatty acids despite SBS.
Conclusion: A strategy of enteral omega-3 supplementation proved safe, balanced n6:n3 lipid delivery, prevented essential fatty acid deficiency and reversed PNAC despite limited enteral alimentation and continued dependence on PN.

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