Mechanisms of Neonatal Intestinal Failure-Associated Liver Disease: Exploring the Gut-Liver Axis

Celeste M Lavallee
Neonates with intestinal failure (IF), who must rely on parenteral nutrition (PN) for growth and maintenance of health, are at risk for intestinal failure-associated liver disease (IFALD). In neonates, short bowel syndrome (SBS) as a result of intestinal resection is the most common cause of IF. SBS patients without a remnant ileum and ileocecal valve (ICV) are considered to have the worst prognosis. The inclusion of fish oil (FO) in the PN lipid emulsion has recently been used as both a
more » ... ed as both a prevention and treatment strategy for IFALD. However, the relationship between IFALD and intestinal anatomy in SBS has not been formally studied. iv These findings suggest that remnant anatomy per se contributes minimally to the early emergence of IFALD. Rather, remnant anatomy likely has a greater impact on intestinal adaptation, and thus on the duration of PN. Furthermore, sepsis during PN is a key contributing factor to early IFALD. Further, these results provide empirical evidence that PN lipid modulation alters the gut microbiota, bile acid metabolism, and bile acid composition. Factors related to intestinal adaptation, the role of sepsis in IFALD, and the mechanisms by which PN lipid alters the gut microbiota should be further explored. v
doi:10.7939/r35x25t85 fatcat:g52wckvu2nbjjmw26i3fropsvm