How fish oil may have saved babies' lives

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How fish oil may have saved babies' lives

 

By Robert Cooke, Globe Correspondent  |  July 3, 2006

 

Like most babies with his medical condition, Austin DuPonte of Hudson

was not expected to live long.

 

He was born prematurely and developed intestinal problems so severe that

surgeries left him unable to absorb enough nourishment. Babies with

bowel troubles can be fed intravenously, but most quickly develop liver

problems.

 

Without a costly liver transplant, and sometimes even with one, these

children usually don't make it to their first birthday.

 

But over the last two years, a simple finding made by doctors at

Children's Hospital Boston has apparently saved the life of Austin and

15 other babies.

 

It's long been known that the intravenous fluid that kept the babies

alive -- called total parenteral nutrition -- was also destroying their

livers. The Children's doctors, led by Dr. Mark Puder, figured out why

total parenteral nutrition seemed to be causing these problems and how

to fix it.

 

They swapped the IV feedings, giving the babies fluids with fish oils,

known as omega-3's, instead of the standard plant oils, or omega-6.

Within weeks, the patients' livers began to rebound, and they no longer

needed transplants.

 

If Puder is right and the plant oils that are totally safe when eaten

become toxic when delivered to the system undigested, his finding might

hold implications for other babies with diseased bowels and even for

adults who are dependent on intravenous feeding -- roughly 30,000 people

a year. Liver disease is a common problem among adults fed

intravenously, too, Puder said.

 

Puder is publishing his findings in today's issue of the journal

Pediatrics and plans to conduct more extensive research to confirm the

early results.

 

``These observations are very important. If they hold up in bigger

trials, it will change treatments and save a lot of babies, " said

pediatrician Richard Deckelbaum, director of the Institute of Human

Nutrition at the Columbia University Medical Center in New York, who was

not involved in the research. ``We need bigger trials -- fast. "

 

Pediatric surgeon Daniel Doody also said he is ``very impressed " with

the results.

``You asked if it´s the greatest thing since sliced bread? The answer

is yes. "

 

Doody, of MassGeneral Hospital for Children, said he heard of Puder's

results and tried the altered intravenous feeding on a sick patient of

his own.

 

``There´s no doubt it improved the immediate outcome for our child, "

who is now awaiting an intestinal transplant, Doody said.

 

Austin DuPonte's mother Joanne said she believes her son would have died

without the altered IV feeding, known as Omegaven. Within two weeks of

starting Omegaven, Austin -- who ``had every single preemie thing you

could have go wrong " -- started to look better.

 

``I 100 percent attribute Austin´s recovery and how well he´s doing

to Omegaven, " she said. ``He is right on track for his adjusted age.

He´s excelling socially, far beyond where they think he should be. "

 

The plant oil discovery came about through a combination of good luck,

good timing, and good instincts. First, Dr. Jennifer Garza, then a

surgical fellow at Children's Hospital, decided to tackle the problem of

infants born with necrotizing enterocolitis -- a severe bowel disorder

that mostly affects premature babies, many of whom then suffer liver

failure.

She asked Puder to supervise her work.

 

In discussing the subject in a meeting with Children's Hospital

colleagues, Dr. Judah Folkman mentioned a study he and Dr. Robert

Shamberger had done 15 years earlier on rats. In that study, rats that

were given a diet of parenteral nutrition developed liver disorders, but

if they got even a tiny amount of normal rat chow, the liver problems

went away. ``So something in the chow was protecting the animals, " said

Puder, who repeated the experiment and found the same results.

 

Then, at the suggestion of clinical pharmacist Dr. Kathleen Gura, they

decided to try the rats on Omegaven.

 

The results were an immediate surprise. The livers of the rats that got

Omegaven looked perfect, while the rats that got the typical IV feed

with plant oils looked terrible.

 

The next step should have been to test the idea in more animals -- but

an emergency intervened.

 

Puder's partner, surgeon Russell Jennings, was treating a 5

1/2-month-old baby, Charles Rolfe, whose liver was failing. He ``urged

me to `save this baby!´ " Puder said.

 

``We asked permission from the Food and Drug Administration, from our

institutional review board, and from the baby´s parents, " he

continued. ``I hoped they´d say no, " because the treatment was so

untested. But everyone said yes.

 

Puder and his colleagues had to guess at the right dosage, but it

worked. Charles, of Mashpee, began to get markedly better on the

Omegaven feedings.

 

Now 2, Charles is ``the cutest little thing in the whole world, " his

mother, Alyson, said. ``He´s got big huge blue eyes and reddish blond

curly hair. He´s a riot. "

 

Although he still needs to be fed intravenously for 11 hours a day,

Charles no longer needs a liver transplant.

 

Puder said his discovery has been the highlight of his professional

life, and he plans to continue researching the possible benefits of

Omegaven.

 

``If this is the only thing I do in my career, that´s fine, " he said.

``This isn´t the end of the story, this is just the beginning. "  

 

© Copyright 2006 The New York Times Company