Fish oil intravenous fat emulsion monotherapy and essential fatty acid requirements
Notice bibliographique
Résumé
We have read with great interest the review article, “Essential fatty acid deficiency in parenteral nutrition: Historical perspective and modern solutions, a narrative review” by Wolff et al. We recently reviewed this literature to evaluate fish-oil intravenous lipid emulsion (FO-ILE) monotherapy in our pediatrics and preterm neonates with intestinal failure associated liver disease. We would like to the potential for calculation errors using Table 2. This table provides examples for calculating the minimum lipid volume needed to prevent essential fatty acid deficiency (EFAD) in a patient, based on age, type of lipid emulsion used, and minimal linoleic acid (LA) intake according to European Society of Paediatric Gastroenterology, Hepatology and Nutrition/European Society for Parenteral and Enteral Nutrition/European Society of Paediatric Research/Chinese Society of Parenteral and Enteral Nutrition joint guidelines.1 Sample calculations from Table 2 state that 10% (0.1 g fat/ml) FO-ILE contains 0.1 g LA/ml when, in fact, it only contains 0.0031 g LA/ml, according to product monograph by Fresenius Kabi pharmaceutical company.2 For a premature infant of 1.5 kg receiving FO-ILE monotherapy, instead of the 15 ml calculation result in Table 2, the minimum fat volume to prevent EFAD would be 121 ml (0.25 g LA/kg × 1.5 kg ÷ 0.0031 g LA/ml), which represents 8 g/kg/day of FO-ILE. This amount is impossible to achieve, considering that the maximum labeled dose of FO-ILE is 1 g/kg/day, with some studies having used doses no higher than 1.5 g/kg/day.3 In comparison, the minimum dose of soybean-oil intravenous lipid emulsions (SO-ILE) and mixed-oil emulsions (soybean oil, medium-chain triglycerides, olive oil, fish oil-intravenous lipid emulsion [SO,MCT,OO,FO-ILE] or OO,SO-ILE) to prevent EFAD for this infant are 0.5 g/kg/day and 1.4 g/kg/day, respectively. The recommended fat dose of these emulsions for premature infants is 3 g/kg/day.4 Therefore, it seems that minimal LA intake can be achieved with SO-ILE,OO,SO-ILE and SO,MCT,OO,FO-ILE but not with FO-ILE monotherapy, which may raise concerns among clinicians treating these patients. A team recently proposed to redefine EFAD because there is no published case report of EFAD in pediatrics on FO-ILE monotherapy.5 We would like to highlight that patients who were treated with FO-ILE monotherapy in published literature also received a proportion of their energy requirements by enteral nutrition, which may have protected them from EFAD. Also, monitoring of EFAD in these patients was conducted with triene/tetraene ratio, which is probably an unreliable marker, as discussed by Wolff and al in their article. Until more is known about minimal requirement of LA downstream metabolites or their minimal plasma levels to prevent EFAD, we believe that FO-ILE monotherapy should be used with caution in premature infants and also in term infants and pediatrics not receiving a substantial proportion of their energy requirements by enteral nutrition. Anne-Sophie Otis drafted the manuscript and all authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript. The authors thank Anne-Sophie Otis (Neonatal Intensive Care Unit Pharmacist), Flavie Pettersen-Coulombe (Pediatric Surgery and Parenteral Nutrition Pharmacist), and Emile Demers (Pediatric Gastroenterology Pharmacist) at CHU Sainte-Justine, Montréal, Canada, for their valuable clinical support and contributions to this study. None declared.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,007 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».