Intravenous Fish Oils in the Treatment of Parenteral Nutrition Liver Injury

Inclusion Criteria: Patients from birth to 18 years of age who: * are receiving PN, * are predicted to receive at least another 30 days of PN, and * have liver disease with at least a serum direct (conjugated) bilirubin ≥ 2 mg/dL * Patients from birth to 18 years of age who have a soybean allergy (per parental report) and require parenteral fat * Patients with significant liver disease due to parenteral nutrition despite utilization of all appropriate conventional therapies. * Signed patient/parent informed consent * Hospitalized due to medical or surgical condition prior to Omegaven initiation Exclusion Criteria: * Those who do not fulfill the inclusion criteria * Those who choose not to consent to the study * Those in whom 3rd party funding is not secured to support this investigational treatment * Known fish or egg protein allergy (per parental report) * All other causes of liver disease (cystic fibrosis, biliary atresia, and alpha 1 anti- trypsin deficiency) * Severe hemorrhagic disorders (platelet count below 50000) * Collapse and shock * Embolism * Undefined coma status * Impaired lipid metabolism (serum triglycerides \> 200 mg/dL on 1 g/kg/day intralipid) * Unstable diabetes mellitus * Stroke * Recent cardiac infarction