The etiology of parenteral nutrition—associated liver disease (PNALD) is complex and multifactorial. Recent evidence suggests that the composition of the intravenous lipid emulsion, which is typically administered as part of parenteral nutrition to provide dense calories and prevent essential fatty acid deficiency, can significantly contribute to PNALD. Since September 2004, Children’s Hospital Boston has been treating patients with PNALD by stopping the conventional soy oil—based emulsions and using one that is composed solely of fish oils. Despite favorable outcomes, concerns about the use of fish oil as monotherapy continue to be raised because of the perceived risks of increased bleeding and essential fatty acid deficiency. This review discusses the published evidence to date describing the efficacy of this novel therapy in the treatment of an often fatal complication of parenteral nutrition use.
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