Can SMOFlipid®, A Composite Parenteral Nutrition Lipid Emulsion, Prevent Progression Of Parenteral Nutrition Associated Liver Disease In Infants?

Inclusion Criteria: 1. ≤ 24 months of age at enrollment 2. Evidence of early hepatic dysfunction * Serum conjugated bilirubin ≥ 17 umol/L on 2 consecutive readings 7 days apart * No evidence of sepsis * Normal Temperature (T between 35.5C and 38.0C) * Normal leukocyte count * Normal platelet count * No systemic septic symptoms * No prior administration of Omegaven 3. ≥ 40% of total calories administered by PN 4. Meet one of the following diagnostic categories * Short Bowel Syndrome * Abdominal surgical procedure including gastroschisis closure by any means and percutaneous drainage procedures within the past 6 months and has been receiving PN since surgery * Intestinal Failure * One of the following diagnoses for which the child is dependent on PN * Gastrointestinal Motility Disorder * Mucosal Enteropathy 5. Expectation of the treating physician that the patient will require PN for at least 3 weeks following enrollment. 6. Parents willing to participate including randomization Exclusion Criteria: 1. Sepsis or Hemodynamic Instability of any cause. 2. Coagulopathy (Platelets ≤ 150 000, or INR ≥ 1.4) 3. Hypersensitivity to fish-, egg- or soy protein or to any of the active substances or excipients 4. Current enrollment in another clinical trial involving a surgical or pharmacologic intervention 5. Serum conjugated bilirubin \> 50 umol/L 6. Hyperlipidaemia (any of) * LDL ≥ 4 mmol/L * HDL ≥ 2 mmol/L * Total cholesterol ≥ 5 mmol/L * Triglycerides ≥ 1.5 mmol/L 7. Treatment with intravenous N-Acetylcysteine or Ursodeoxycholic acid 8. Renal insufficiency * Creatinine ≥ 80 umol/L 9. Disorders of Fluid Balance (any of) * Serum Sodium \< 130 mmol/L * Serum Sodium \> 145 mmol/L 10. Unstable conditions * Acute pulmonary edema * Decompensated cardiac insufficiency * Severe post-traumatic conditions * Uncompensated diabetes mellitus * Acute myocardial infarction * Stroke within 3 months * Thromboembolic event within 3 months * Metabolic acidosis * Serum Bicarbonate \< 17 mmol/L