Reversal of Intestinal Failure–Associated Liver Disease in an Infant Treated With Mixed Lipid Emulsion and Multidisciplinary Intestinal Rehabilitation Program

Intestinal failure–associated liver disease (IFALD) can lead to increased morbidity and mortality in patients with intestinal failure (IF). We report the case of a premature infant born at 25 weeks’ gestation at a neighboring facility that developed surgical necrotizing enterocolitis and secondary IF with 6 cm of small bowel remaining measured from the ligament of treitz with jejunocolonic anastomosis. The patient's course was complicated by IFALD and transferred to our intestinal rehabilitation program at 3 months of age. He was treated with SMOF lipid in reduced lipid dosages to prevent and treat IFALD, including cycling of parenteral nutrition, monitoring of the glucose infusion rate, and adjusting the micronutrient, trace elements, and aggressive enteral feeding. Omegaven had not yet been approved during the time of this case presentation. During the course of his treatment, he experienced normalization of his liver profile tests and progressed toward enteral autonomy.