Low Dose Fat for the Prevention of Liver Disease in Babies With Gastrointestinal Disorders
Neonates with congenital/acquired gastrointestinal disorders are at high risk for Parenteral Nutrition Associated Cholestasis (PNAC). Besides enteral nutrition, standard therapies to prevent and treat PNAC have been limited and marginal. Recently, the dose and composition of standard intravenous fat emulsions have implicated in the development and progression of PNAC.
In this study, neonates with congenital/acquired gastrointestinal disorders will be randomized, in a unblinded fashion, to receive either the standard dose of an intravenous omega-6 fatty acid emulsion or a low dose of an intravenous omega-6 fatty acid emulsion throughout their course of PN or until hospital discharge, death or 100 days of life, whichever comes first. The primary outcome will be the presence of cholestasis at 28 days or when full feeds are reached, whichever is longer.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Low Dose Parenteral Fat for the Prevention of Parenteral Nutrition Associated Cholestasis in Neonates With Congenital/Acquired Gastrointestinal Disorders|
- presence of cholestasis [ Time Frame: 28 days of life or when full feeds are reached whichever is longer ] [ Designated as safety issue: Yes ]Cholestasis will be defined by a direct bilirubin > 2 mg/dL on two consecutive occasions
- mortality rate [ Time Frame: at the end of the hospital stay which is expected to be an average of 5 weeks ] [ Designated as safety issue: Yes ]
- anthropometric measurements [ Time Frame: 28 days and at the end of the hospital stay which is expected to be an average of 5 weeks ] [ Designated as safety issue: Yes ]Growth will be assessed by growth velocity and z-scores at 28 days days of life and at end of the hospital stay
|Study Start Date:||December 2010|
|Estimated Study Completion Date:||December 2015|
|Estimated Primary Completion Date:||December 2015 (Final data collection date for primary outcome measure)|
|low dose intravenous fat emulsion||
The subject will receive 1 gm/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first.
|standard dose intravenous fat emulsion||
The subject will receive 3 gm/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first.
Parenteral Nutrition (PN) acts as an intravenous source of both macronutrients and micronutrients when enteral feeds are not possible. Intravenous fat emulsions often supplement PN and provide a dense source of non-protein calories and essential fatty acids. Although PN is life-sustaining, it is associated with a myriad of life-threatening complications including Parenteral Nutrition Associated Cholestasis (PNAC). Children dependent on PN for an extended period of time are high risk for liver failure.
The etiology of PNAC remains poorly understood. Neonates with congenital and acquired gastrointestinal disorders are at high risk for PNAC and its subsequent complications. Examples of these gastrointestinal disorders include gastroschisis, volvulus, atresias, dysmotility and malabsorption disorders, pseudo-obstruction, and Hirschsprung's disease. These disorders often render the gut non-functional for extended periods of time. As a result, these patients become PN-dependent and develop PNAC.
Specific PN components have been implicated in the pathogenesis of PNAC. More recently, standard intravenous fat emulsions have been labeled as one of the main culprits contributing to PNAC. Standard intravenous fat emulsions are dosed as high as 4 mg/kg/d and are derived from soybean and/or safflower oil, which are rich in omega-6 fatty acids and contain a paucity of omega-3 fatty acids. It is unclear if the dose or high omega-6 fatty acid:omega-3 fatty acid ratio is responsible for the development of PNAC.
The primary specific aim of this study is to determine if PNAC is related to the amount of standard intravenous fat emulsion administered to neonates with congenital/acquired gastrointestinal disorders. The investigators hypothesize that the PNAC is unrelated to the dose of intravenous fat emulsions. To test this hypothesis, neonates with congenital/acquired gastrointestinal disorders will be randomized to low dose standard soybean based parenteral fat, 1 gm/kg/d, or standard dose soybean parenteral fat, 3 gm/kg/d. Secondary outcomes include: mortality rate, length of stay, and anthropometric measurements at 28 days of life and at the end of the hospital stay, which is expected to be an average of 5 weeks.
|Contact: Kara L Calkins, MD||310 206 6197||KCalkins@mednet.ucla.edu|
|Contact: Lauren A Molchan, BS||310 794 9460||LMolchan@mednet.ucla.edu|
|United States, California|
|University of California, Los Angeles||Recruiting|
|Los Angeles, California, United States, 90095|
|Contact: Kara L Calkins, MD KCalkins@mednet.ucla.edu|
|Contact: Lauren A Molchan, BS LMolchan@mednet.ucla.edu|
|Sub-Investigator: Stephen B Shew, MD|
|Sub-Investigator: Robert Venick, MD|
|United States, Missouri|
|Saint Louis University||Recruiting|
|Saint Louis, Missouri, United States|
|Contact: Thomas Havranek, MD|
|Principal Investigator:||Calkins L Calkins, MD||University of California, Los Angeles|