Omegaven as Alternative Parenteral Fat Nutrition

Inclusion Criteria

• •Greater than 14 days old
• •Has parenteral nutrition 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
• •Patient is parenteral nutrition dependent (unable to meet nutritional needs solely by enteral nutrition) and are expected to require parenteral nutrition for at least 3 more weeks
• •Patient has not responded to other therapeutic approaches for parenteral nutrition-associated liver disease such as : cycling of parenteral nutrition, avoiding overfeeding, reduction/removal of copper and manganese from parenteral nutrition, advancement of enteral feeding, and use of Ursodiol
• •Patient has been on at least 2 weeks of SMOFLIPIDs with no improvement or worsening of direct bilirubin levels
• •Signed patient informed consent
• •The patient is expected to have a reasonable possibility of survival
• •No other known etiology of cholestasis other than parenteral nutrition-associated liver disease at the time of Omegaven® initiation