Neonatal Lymphatic Disorders — Oils for Essential Fatty Acid (EFA) Supplementation — Clinical Pathway: Inpatient

Management of Infants with Lymphatic Disorders Clinical Pathway — Inpatient

Oils for Essential Fatty Acid (EFA) Supplementation

Rationale

  • Infants receiving a diet with limited long chain fat are at risk for developing essential fatty acid deficiency (EFAD)
  • EFAD can often be prevented by providing small amounts of the essential fatty acids:
    • Linoleic acid (18:2n-6) and α-linolenic acid (18:3n-3)
  • Walnut oil provides a good source of linoleic acid in a small volume, and flaxseed oil has a high content of:
    • α-Linolenic acid: These oils are readily obtainable in many grocery stores and can be used in the hospital or home setting
  • The amount of long-chain fat provided should be limited to prevent reaccumulation of the chylous pleural effusions or lymphatic drainage, yet sufficient to meet EFA needs

Monitoring

Laboratory

  • Laboratory assays are available to aid in the diagnosis of EFAD
  • Of particular importance when monitoring for EFAD are:
    • Triene: Tetraene ratio (plasma eicosatrienoic acid:arachidonic acid)
    • Linoleic acid (C18 2w6)
    • α-Linolenic acid (C18 3w3)
    • Mead acid (C20 3w9)
  • Note that reference ranges for normative values vary based on the assay used and must be considered when assessing and making a determination of EFAD

Clinical Signs and Symptoms of Essential Fatty Acid Deficiency

  • Dry scaly rash
  • Decreased growth in infants and children
  • Alopecia
  • Thrombocytopenia
  • Increased susceptibility to infection
  • Poor wound healing
  • In children, intellectual disability

    • Tolerance

    α-Linolenic acid (18:3n-3)

    • Although flaxseed oil is generally well tolerated, high doses may cause loose stools or diarrhea
    • Allergic and anaphylactic reactions although reported with flaxseed and flaxseed oil ingestion, are rare

    Absorption

    • All omega-3 fatty acid supplements are absorbed more efficiently with meals
    • Dividing daily dose into 2 or 3 smaller doses during the day decreases GI effects

    Adequate Intake

    • Varied recommendations for adequate intake (AI) exist from various agencies
    • General recommendations can be summarized as follows:
      • Provide 2-4% of calories from linoleic acid (18:2n-6),usually 3%
        • Follow essential fatty acid profiles, if evidence of EFAD, may need to increase % of calories from LA and/or ALA
        • e.g., If patient is receiving 4% of calories from LA, clinician may consider increasing to 6% of calories
      • Provide 0.5-1.5% of calories from α-linolenic acid (18:3n-3), usually 1%