Requirement of parenteral fat in infants with biliary atresia.

In a prospective study on infants with biliary atresia (BA) we measured the composition of the plasma fatty acid to determine the requirement of fat emulsion. In 14 infants who underwent initial operation for treatment of BA, a trend toward essential fatty acid (EFA) deficiency was evident before the surgery. Fourteen infants given parenteral nutrition (PN) after surgery were grouped into three according to the dose of fat emulsion, fat free in 4, 10% of the total calories in 5 and 20% of the total calories in 5. After operation, EFA deficiency gradually progressed when on fat free PN. Improvement in EFA deficiency occurred with the administration of fat which corresponded to 20% of the total caloric intake. During PN including fat emulsion, abnormal changes in liver function tests and serum lipid values due to fat emulsion were nil. Infusion of fat which supplies 20% of the total calories is thus recommended for correction of EFA deficiency and is tolerable in infants with obstructive liver disease. However, clinical and biochemical monitoring should be carefully done.