Because of higher metabolic demands, insufficient nutrition, intestinal malabsorption, chronic liver disease, and other comorbidities, infants with intestinal failure (IF) and IF-associated liver disease (IFALD) are at risk for poor somatic growth. In the case of intestinal failure, there is insufficient evidence on the nutritional adequacy of intravenous fish oil lipid emulsion (FOLE) compared to conventional soybean oil lipid emulsion (SOLE). To characterise the development trends of a large group of babies with IFALD who were treated with FOLE. The study compared growth data from newborns in a single-center, prospective FOLE trial to published standards and a multicenter, historical cohort of infants with IF treated with SOLE. FOLE was used to treat 138 babies with IFALD while SOLE was used to treat 108. Infants in both groups from 6 to 11 months postmenstrual age had lower mean weight- and length-for-age z scores when compared to WHO normative growth curves and published preterm data. Infants treated with FOLE had a mean weight-for-age z-score of 0.13 and a length-for-age z-score of 0.07 at 24 months postmenstrual age when compared to WHO growth statistics. Infants treated with SOLE had a mean weight for age z-score of 0.93 and a mean length for age z-score of 2.33 at 24 months postmenstrual age, in comparison. Older postmenstrual age at baseline, fewer central line-associated blood stream infections, cholestasis resolution, type of intravenous fat emulsion (FOLE vs SOLE), and female sex were all independent predictors of greater weight, length, and head circumference z-scores.
Infants with IFALD treated with FOLE exhibited comparable somatic growth to those treated with SOLE in early infancy, as well as better somatic growth up to 24 months of age, indicating that it should be used more widely in this patient group.