Clinical trial NCT02334293: Omegaven® as Parenteral Nutrition
Official title: Omegaven® as Parenteral Nutrition
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Cholestasis
Keywords: Omegaven
parenteral nutrition
liver disease
liver injury
Lead sponsor: Carle Foundation Hospital
Sponsor class: OTHER
First posted: 2015-01-08
Enrollment: 25
Sex: ALL
Minimum age (years): 14
Maximum age (years): 4
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine if a fat emulsion comprised of omega-3 fatty acids, Omegaven, would be beneficial in the management of steatotic liver injury in parenteral nutrition (PN) by its inhibition of de novo lipogenesis, the reduction of arachidonic acid-derived inflammatory mediators, prevention of essential fatty acid deficiency through the presence of small amounts of arachidonic acid, and improved clearance of lipids from the serum.


Eligibility criteria: Inclusion Criteria:

* Greater than 14 days old.
* Have PN-associated cholestasis defined as at least 2 consecutive direct bilirubin \>2 mg/dL with anatomical or functional short gut (OR \>4 mg/dL if intact intestine) obtained at least 1 week apart with a ratio of direct: total bilirubin \> 0.4.
* Patients will be PN dependent (unable to meet nutritional needs solely by enteral nutrition) and are expected to require PN for at least 4 more weeks.
* Patients must have failed standard therapies for Parenteral Nutrition Associated Liver Disease (PNALD) including: cycling of PN, avoiding overfeeding, reduction/removal of copper and manganese from PN, advancement of enteral feeding, and use of ursodiol (i.e. Actigall).
* Signed patient informed consent.
* The patient is expected to have a reasonable possibility of survival.
* No other known etiology of cholestasis other than PNALD at time of Omegaven® initiation.

Exclusion Criteria:

* Causes of cholestasis other than PNALD including but not limited to Hepatitis C, Cystic fibrosis, biliary atresia, and alpha 1 anti-trypsin deficiency, prior to Omegaven® initiation.
* Known fish or egg allergy
* Any of the contraindications to use of Omegaven®:

  1. Active new infection at the time of initiation of Omegaven®
  2. Hemodynamic instability
  3. Use of medications with associated risk of bleeding, including nonsteroidal antiinflammatory drugs (NSAIDs)
  4. Active coagulopathy or bleeding
  5. Thrombocytopenia
  6. Unstable hyperglycemia
  7. Impaired lipid metabolism (triglycerides \>1000 mg/dL) while on 1 g/kg/day or less of Intralipid
  8. History of severe hemorrhagic disorders (ie. hemophilia, Von Willebrand disease, etc.)
  9. Unstable diabetes mellitus
  10. Collapse and shock
  11. Stroke/ Embolism
  12. Cardiac infarction within the last 3 months
  13. Undefined coma status
* Enrollment in a clinical trial involving an investigational agent (unless approved by the designated physicians on the multidisciplinary team)
* The parent or guardian of child is unwilling to provide consent or assent

Primary outcomes:
measure: Primary Outcomes/Endpoints ( time from baseline until the patient normalizes bilirubin (presents three consecutive direct bilirubin ≤ 2 mg/dL or a direct bilirubin ≤ 2 mg/dL and weaned from PN)
timeFrame: Until weaned from PN
Secondary outcomes:
measure: Growth (weight three times per week, length once weekly, and head circumference)
timeFrame: Until weaned from PN
measure: Essential Fatty Acids (evidence of essential fatty acid (EFA) deficiency)
timeFrame: Until weaned from PN
Other outcomes:
Locations:
city: Urbana
country: United States
facility: Carle Foundation Hospital
state: Illinois
Study officials:
affiliation: Carle Foundation Hospital
name: William Stratton, MD
role: PRINCIPAL_INVESTIGATOR
References: