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Care of the Premature and Ill Neonate
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Ting Ting Fu, Kera McNelis, Carrie Smith, Jae H. Kim
The type of lipid emulsion should be considered as well (Chapter 9). Soybean oil emulsions, which contain both omega-6 (linoleic acid) and omega-3 (-linolenic acid) fatty acids, have been used traditionally, but metabolites of linoleic acid may induce inflammation and toxic effects. Fish oil-containing emulsions such as SMOFlipid® (soy, medium-chain triglycerides, olive, and fish oils) and Omegaven® contain predominantly omega-3 fatty acids, which may be more hepatoprotective. Smaller studies have shown reduced cholestasis when fish oil-containing emulsions are used preemptively, but this has not been demonstrated by larger studies. Currently, there is insufficient evidence to support its routine use to prevent or reduce neonatal morbidities. Omegaven is typically reserved for patients with liver compromise.
Management of Short Bowel Syndrome After Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
A variety of newer lipid preparations have been shown to decrease the incidence of IFALD; these formulations decrease omega-6 fatty acids and increase omega-3 fatty acids. A preparation consisting entirely of fish oil, such as Omegaven, is one such option, as is a combination emulsion formulation including soy, medium-chain triglyceride, olive, and fish oils (SMOF). While long-term evaluation of these options is limited, preliminary results demonstrate promising decreases in cholestasis while maintaining appropriate fatty acid levels (2).
Nutrition
Published in Prem Puri, Newborn Surgery, 2017
Use of Omegaven, a lipid emulsion of 10% fish oil. Fish oil is high in Ω-3 fatty acids and low in phytosterols, so it has been suggested to reverse cholestasis in surgical infants on long-term PN.46 Use of Omegaven as the only lipid source could, however, potentially result in essential fatty acid deficiency, due to lack of Ω-6 fatty acids, and could also result in poor growth, as the dose of Omegaven is limited to 1.0 g kg−1 day−1 (compared with 3 g kg−1 day−1 for soybean-based lipid emulsions).
Current strategies for managing intestinal failure-associated liver disease
Published in Expert Opinion on Drug Safety, 2021
Jordan D Secor, Lumeng Yu, Savas Tsikis, Scott Fligor, Mark Puder, Kathleen M Gura
The aforementioned studies suggest that FOLE monotherapy appears to be a safe, suitable, long-term lipid alternative to SOLE for patients with IFALD. FOLE promotes resolution of cholestasis and adequately supports growth and development without increased risk of EFAD. In 2020, Gura et al, utilizing the data from the Omegaven® (Fresenius Kabi AG, Bad Homburg, Germany) FDA application, evaluated 125 children with IFALD treated with FOLE (1 g/kg/d, n = 82) or SOLE (3 g/kg/d, n = 42) as part of a multicenter, retrospective pair-matched study [50]. They reported age-appropriate growth z-scores in the FOLE subjects and no differences in growth between the groups.
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Vitamin E has antioxidant properties with literature postulating a protective mechanism against IFALD [50]. Despite supplementation, PN dependent patients as well as those weaned off of parenteral support have demonstrated deficiency at rates as high as 60% [38]. Vitamin E provision is substantially higher in newer lipid formulations such as SMOFlipidTM and OmegavenTM (approximately 200 mg/L) than in previous soy-based formulations (15 mg/L) [51].
Low dose radiation, inflammation, cancer and chemoprevention
Published in International Journal of Radiation Biology, 2019
Al Maqsudur Rashid, Latha Ramalingam, Arwa Al-Jawadi, Naima Moustaid-Moussa, Hanna Moussa
A few animal studies have explored the protective effects on PUFAs concerning irradiation (Tables 1 and 2). Injury of the gastrointestinal (GI) tract caused by irradiation reduces villi to crypt height ratio and increases pro-inflammatory cytokines in the GI tract (Sun et al. 2014). PUFAs are known to protect against radiation-induced GI disorders such as ulcerative colitis or short bowel syndrome by reducing inflammation (Sun et al. 2014). In the study by Sun et al., mice were supplemented with or without PUFAs (Omegaven) and then subjected to 4 Gy/min rate of irradiation. They also exhibited increased villi to crypt ratio depth and reduced mortality rates. The authors suggested the possible mechanisms are through reduced inflammation and lipid peroxidation, as indicated by observed higher levels of superoxide dismutase. n-3 PUFAs have been found to inhibit the migration of metastatic breast cancer cells (Mandal et al. 2010). Furthermore, PUFA supplementation to mice implanted with clonal breast cancer cells MDA-MB-231 brought about significant decreases in tumor volume and weight compared to control animals (Wu et al. 2005). Another study tested the effects of n-3 PUFA enriched diet on human breast cancer xenograft growth and angiogenesis with and without radiation in mice (Hardman et al. 2005); the study showed that incorporating n-3 into the diet increased production of anti-oxidant enzymes in normal cells, thereby protecting them from radiation damage. Furthermore, n-3 protected the bone marrow and the small intestine (Hardman et al. 2005). A few clinical trials have been conducted with n-3 PUFAs (Pilkington et al. 2013). An interesting role of n-3 PUFAs was identified in mitigating the effects of ultraviolet (UV) low dose radiation exposure (Pilkington et al. 2013). The experimental data suggest that n-3 PUFA might protect against skin cancer by suppressing cell-mediated immunity, reducing tumor multiplicity and raising tumor latency (Pilkington et al. 2013). PUFA supplementation has been shown to improve chemotherapy and radiation efficacy. However, these effects were dependent on whether PUFAs were administrated in combination as fish oil or as single n-3 fatty acid (Wynter et al. 2004). These effects are due to changes in membrane lipid fluidity and increases in lipid peroxidation (Corsetto et al. 2017).