About

Kathleen M Gura is an Assistant Professor of Pediatrics at Harvard Medical School and the manager for Pharmacy Research Programs at Boston Children's Hospital. She is a member of the Clinical Nutrition Service in the Division of GI/Nutrition at Boston Children's Hospital. Certified as a Nutritional Support Pharmacist, Dr. Gura has been recognized as the 2020 ASPEN Nutrition Champion and received the Richard A. Helms Award of Excellence in Pediatric Pharmacy Practice by the Pediatric Pharmacy Association in 2020. She has authored numerous book chapters on pediatric nutrition and has written more than 140 peer-reviewed papers on topics such as intestinal failure associated liver disease, intravenous lipid emulsions, and the use of parenteral nutrition in neonates. Dr. Gura has served as an associate editor for the Journal of Parenteral and Enteral Nutrition (JPEN) and is a current member of the board of directors for the American Society for Parenteral and Enteral Nutrition.

Research topics

• Medicine
• Intensive care medicine
• Family medicine
• Pediatrics
• Internal medicine

Selected publications

• High dose fish oil lipid emulsion (FOLE) use in pediatric patients: A case series

  Intestinal failure. · 2026-03-27

  articleOpen accessSenior author

  Intestinal Failure-Associated Liver Disease (IFALD) presents significant challenges in pediatric patients on long-term parenteral nutrition (PN). Case report: We conducted a case series to evaluate safety and efficacy of administering higher dose (2 g/kg/day) Omegaven® (Fresenius Kabi AG, Bad Homburg, Germany), a fish oil-based lipid emulsion (FOLE), in pediatric patients with IFALD. Ten patients at Boston Children's Hospital were found to have received FOLE at 2 g/kg/day. Data was retrospectively collected from electronic health records, including demographics, laboratory values, and treatment outcomes. Conclusion: All patients using higher dose FOLE successfully transitioned to 20-hour PN cycles with FOLE 2 g/kg/day, meeting daily caloric requirements and preventing hypoglycemia. No adverse reactions were reported. For most patients, liver function markers remained within normal limits. Our findings suggest higher dose FOLE can facilitate PN cycling and promote growth. Further studies are warranted to validate these findings and establish optimal dosing for this patient population.

  PublisherDOI

• ESPEN practical guideline on ethical aspects of medical nutrition therapy

  Clinical Nutrition · 2026-03-14

  article
  PublisherDOI

• A medium-chain fatty acid analogue prevents endotoxin liver injury in a murine model

  Scientific Reports · 2025-04-20 · 1 citations

  articleOpen access

  Parenteral nutrition (PN) is lifesaving for patients with short bowel syndrome and other gastrointestinal disorders, however long-term use may lead to complications including hepatosteatosis and sepsis. We have previously demonstrated the anti-steatotic, -fibrotic, and -inflammatory properties of SEFA-6179, an engineered medium-chain fatty acid analogue. We hypothesized that SEFA-6179 treatment would protect against endotoxin-induced liver injury in a murine model of PN-induced hepatosteatosis. C57Bl/6J mice were administered a high-carbohydrate liquid diet plus intravenous lipid emulsion (Intralipid, 4 g fat/kg/d) or intravenous saline for 19 days to induce hepatosteatosis. SEFA-6179 (100 mg/kg) or vehicle (MCT/medium-chain triglyceride) was administered via oral gavage for four days leading up to intraperitoneal challenge with lipopolysaccharide (15 mg/kg) or saline on day 19. Age-matched, chow-fed controls received the same treatments. The primary outcome was liver biomarkers: alanine aminotransferase and aspartate aminotransferase. Pro-inflammatory cytokines, IL-6, TNF-alpha, and monocyte chemoattractant protein (MCP1), were analyzed. Liver immunofluorescence staining was performed to evaluate macrophage phenotypes. In endotoxin-challenged mice, pre-treatment with SEFA-6179 lowered liver enzymes and pro-inflammatory cytokine levels compared to vehicle. On liver histology, SEFA-6179 pre-treatment led to greater polarization of M1/pro-inflammatory macrophages to an M2/anti-inflammatory phenotype compared to vehicle. SEFA-6179 is currently in Phase II clinical trials. These findings support the potential application of SEFA-6179 in high-risk, PN-dependent patients.

  PublisherOA PDFDOI

• Clinical Nutrition in Critical Illness

  2025-01-01 · 1 citations

  book-chapter1st authorCorresponding
  PublisherDOI

• Essential fatty acid deficiency in children treated with long‐term 100% fish‐oil lipid injectable emulsion: A longitudinal descriptive cohort study

  Journal of Parenteral and Enteral Nutrition · 2025-06-19 · 1 citations

  article1st author

  BACKGROUND: To assess severity and risk of an essential fatty acid deficiency in children <2 years with parenteral nutrition-associated cholestasis on long-term 100% fish-oil lipid injectable emulsion. METHODS: This longitudinal descriptive cohort study included patients receiving fish-oil lipid injectable emulsion (1 g/kg/day). Triene: tetraene ratios were monitored for up to 4 years and classified as mildly elevated (≥0.05 and <0.2) or essential fatty acid deficiency (≥0.2). RESULTS: One hundred and twenty-seven patients with a baseline median age of 14 weeks were included. Serum docosahexaenoic acid and eicosapentaenoic acid levels markedly increased, whereas arachidonic acid, linoleic acid, and α-linolenic acid levels decreased before stabilizing. Median triene: tetraene ratios peaked at 0.027 at week 8 and then stabilized within a range of 0.015 and 0.020 from week 16 until the end of the study. Seven patients had mildly elevated triene: tetraene ratio at the end of the study. Three infants had an essential fatty acid deficiency, but none demonstrated clinical signs consistent with this deficiency. One deficiency was attributed to a laboratory error; two were associated with adverse events. All patients resolved with the continuation of fish-oil lipid injectable emulsion. CONCLUSION: Children with parenteral nutrition-associated cholestasis on long-term fish-oil lipid injectable emulsion are at low risk for a clinical or biochemical essential fatty acid deficiency. These findings indicate that despite its low content of linoleic acid and α-linolenic acid, long-term 1 g/kg/day of 100% fish-oil lipid injectable emulsion is not associated with an essential fatty acid deficiency.

  PublisherDOI

• In defense of the Holman index: Defining fatty acid deficiency

  Nutrition · 2025-12-11

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Intravenous lipid emulsions designed to meet preterm infant requirements increase plasma and tissue levels of docosahexaenoic acid and arachidonic acid in mice

  Clinical Nutrition · 2024-08-24 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Fish oil lipid emulsion compared with soybean oil lipid emulsion in pediatric patients with parenteral nutrition‐associated cholestasis: A cost‐effectiveness study

  Journal of Parenteral and Enteral Nutrition · 2024-12-21 · 2 citations

  article

  OBJECTIVES: Evidence indicates that, in pediatric patients with parenteral nutrition-associated cholestasis (PNAC), the use of a 100% fish oil lipid emulsion (FOLE) increased the likelihood of PNAC resolution and reduced the likelihood of liver transplantation compared with a 100% soybean oil lipid emulsion (SOLE). To evaluate the potential economic benefit, we conducted a cost-effectiveness analysis comparing FOLE with SOLE. STUDY DESIGN: A discrete event simulation model evaluated cost-effectiveness by simulating clinical outcomes and estimating associated healthcare costs in pediatric patients with PNAC receiving parenteral nutrition (PN) with FOLE (1 g/kg) or SOLE (1.9 g/kg) over a time horizon of 6 years. Model inputs for clinical outcomes were derived from the integrated analysis of two US Phase 3 trials (NCT00910104 and NCT00738101). Cost estimates were estimated from the perspective of the US payer including the cost of PN, transplantation, and adverse events. RESULTS: The total cost associated with FOLE was $69,847 USD vs $141,605 USD for SOLE. The cost reduction of $71,757 USD was attributable to the avoidance of liver transplantation (-15.7%) and reduction in adverse events (-4.8%). Life-years and the quality-adjusted life-years were increased with FOLE compared with SOLE (by 0.248 and 0.295, respectively). CONCLUSION: By reducing the need for liver transplant and providing time to transition to full enteral nutrition, FOLE leads to cost-savings, compared with SOLE, in pediatric patients with PNAC in the perspective of the US payer. These findings support the use of FOLE in pediatric patients with PNAC who require PN.

  PublisherDOI

• Inflammation drives pathogenesis of early intestinal failure-associated liver disease

  Scientific Reports · 2024-02-20 · 11 citations

  articleOpen access

  Patients with intestinal failure who receive long-term parenteral nutrition (PN) often develop intestinal failure-associated liver disease (IFALD). Although there are identified risk factors, the early pathogenesis is poorly understood and treatment options are limited. Here, we perform a transcriptomic analysis of liver tissue in a large animal IFALD model to generate mechanistic insights and identify therapeutic targets. Preterm Yorkshire piglets were provided PN or bottle-fed with sow-milk replacer for 14 days. Compared to bottle-fed controls, piglets receiving PN developed biochemical cholestasis by day of life 15 (total bilirubin 0.2 vs. 2.9 mg/dL, P = 0.01). RNA-Seq of liver tissue was performed. Ingenuity Pathway Analysis identified 747 differentially expressed genes (343 upregulated and 404 downregulated) with an adjusted P < 0.05 and a fold-change of > |1|. Enriched canonical pathways were identified, demonstrating broad activation of inflammatory pathways and inhibition of cell cycle progression. Potential therapeutics including infliximab, glucocorticoids, statins, and obeticholic acid were identified as predicted upstream master regulators that may reverse the PN-induced gene dysregulation. The early driver of IFALD in neonates may be inflammation with an immature liver; identified therapeutics that target the inflammatory response in the liver should be investigated as potential treatments.

  PublisherOA PDFDOI

• Pharmacologic challenges in pediatric intestinal failure: A review

  Intestinal failure. · 2024-10-01 · 2 citations

  reviewOpen accessSenior author

  Although the hallmark of intestinal failure (IF) management - also known as intestinal rehabilitation - is parenteral nutrition, many of the complications that arise from this complex condition require additional pharmacologic interventions to prevent more serious consequences such as intestinal failure associated liver disease and central line associated bloodstream infections. This brief review highlights some of the more commonly used treatment strategies in pediatric patients with IF along with a review how different types of short bowel anatomy impact drug administration.

  PublisherOA PDFDOI

Frequent coauthors

• Mark Puder

  Boston Children's Hospital

  219 shared

• Scott C. Fligor

  Boston Children's Hospital

  57 shared

• Savas T. Tsikis

  Harvard University

  57 shared

• Christopher Duggan

  53 shared

• Paul D. Mitchell

  Boston Children's Hospital

  47 shared

• Alexis K. Potemkin

  Boston Children's Hospital

  42 shared

• Thomas I. Hirsch

  Harvard University

  42 shared

• Clifford Lo

  37 shared

Awards & honors

• 2020 ASPEN Nutrition Champion
• 2020 Richard A. Helms Award of Excellence in Pediatric Pharm…