Improvement in Parenteral Nutrition–Associated Cholestasis With the Use of Omegaven in an Infant With Short Bowel Syndrome

Background: Parenteral nutrition–associated cholestasis (PNAC) and liver disease have been associated with soybean oil–based intravenous fat emulsions (IVFEs). The benefit of fish oil–based IVFEs in the reversal of parenteral nutrition (PN)–associated liver damage includes allowing for longer PN duration without immediate need for bowel or liver transplantation. Methods: The present case involves an infant born with short bowel syndrome (SBS) requiring long-term PN with development of PNAC and subsequent administration of a fish oil-based IVFE. Results: An infant born with SBS was initiated on PN and enteral feeds. After failed enteral progression, bowel lengthening by serial transverse enteroplasty (STEP) resulted in postoperative ileus with delayed enteral feeding for 4 weeks. The administration of long-term PN led to development of PNAC, resulting in initiation of a fish oil–based IVFE. After 4 months, the cholestasis had resolved. Despite the STEP, at 16 months, the child required bowel tapering due to inability to advance enteral feeding. Conclusions: Fish oil–based IVFE was effectively used to reverse PNAC in a child with SBS. Despite early STEP, the patient was not able to tolerate enteral feedings and required bowel tapering. This case illustrates that early surgical intervention did not allow for improved feed tolerance. This resulted in a significant period without enteral nutrition, leading to development of cholestasis. The use of fish oil–based IVFE may permit a longer duration of PN administration without the development of cholestasis or liver disease, allowing for longer time for bowel adaptation prior to the need for surgical intervention.