Cholestasis, Short Bowel Syndrome
Conditions
Keywords
Short bowel syndrome, Cholestasis, Omegaven, Parenteral nutrition-associated Liver Disease
Brief summary
This pilot study seeks to demonstrate the efficacy of an intravenous lipid preparation high in omega-3 fatty acids (Omegaven) in the treatment of cholestasis in parenteral nutrition dependent patients with short gut syndrome.
Interventions
DRUGOmegaven Therapy
After baseline labs, which have been collected no earlier than seven days prior to the initiation of therapy are obtained, therapy with Omegaven will be initiated at a starting dose of 0.5 g/kg/day infused over 12 hours. If tolerated, the dose will be increased to 1 g/kg/day, the goal dose. Omegaven will be infused intravenously through either a central or peripheral catheter in conjunction with parenteral nutrition.
Sponsors
Amarnath, Rathna, M.D.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 1 Years
Healthy volunteers
No
Inclusion criteria
* Patient will be dependent upon parenteral nutrition (PN) * Patient will have short gut syndrome (loss of \>50% of small bowel) * Patient's guardian/caregiver provides informed consent for patient to receive therapy * Pediatric patient ≤ 1 year of age * Expected PN duration is greater than 30 days * Direct bilirubin \>2.0 mg/dL measured on two occasions no more than one week apart
Exclusion criteria
* Liver dysfunction secondary to cause other than PN verified by standard of care diagnostic procedures and lab work to rule out alternative causes of neonatal cholestasis. * Any patient in whom Omegaven therapy would be contraindicated, such as an allergy to any seafood product, egg protein, and/or previously established allergy to Omegaven * impaired lipid metabolism * severe hemorrhagic disorder * unstable diabetes mellitus * collapse and shock, stroke/embolism, recent cardiac infarction, or undefined coma status
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improvement of liver dysfunction as measured by time to achieve 50 % decrease in direct bilirubin | weekly then biweekly data collection | Direct bilirubin will be collected at baseline, then weekly for 30 days, and then biweekly, thereafter, up to an expected average of 108 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| a) Maintenance of nutritional status | Labwork will be collected at baseline, then weekly for the first month. Thereafter, a lipid panel will be collected every 2 months, complete metabolic panel every 2 weeks, and essential fatty acid profile monthly, up to an expected average of 108 weeks | Nutritional status will be monitored by reviewing complete metabolic panel, magnesium, weight, vitals, phosphorus, prealbumin, lipid panel, and essential free fatty acid profile. The essential fatty acid profile will be checked at baseline and then monthly for at least 6 months until the patient is determined to be receiving at least 2.7% of caloric intake from linoleic acid. If the patient's essential fatty acid profile indicates that the patient is absorbing adequate amounts of essential fatty acid, the essential fatty acid profile will be discontinued . |
| Occurrence of potential adverse side effects | biweekly labwork up to an expected average of 108 weeks | Adverse events may include but are not limited to prolonged prothrombin time, hypertriglyceridemia, and anaphylaxis in relation to the patient's therapy. |
| c) Resolution of liver dysfunction | weekly complete metabolic panel for the first month and then biweekly thereafter, up to an expected average of 108 weeks | Resolution of liver dysfunction will be defined by achievement of normal direct bilirubin, aspartate aminotransferase and alanine transaminase. |
Countries
United States
Outcome results
None listed