Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants
LIN Hui-Jia, SHEN Xiao-Xia, NI Ying-Hua, MA Xiao-Lu, SHI Li-Ping, DU Li-Zhong
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health, Hangzhou 310052, China
Abstract：Objective To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight (ELBW) infants. Methods A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1, 2018 to July 30, 2020, with an age of ≤14 days on admission and a duration of parenteral nutrition of > 14 days. According to the type of lipid emulsion received, the ELBW infants were divided into two groups: soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) (n=26) and medium-chain triglycerides/long-chain triglycerides (MCT/LCT) (n=23). The two groups were compared in terms of clinical features, complications, nutrition support therapy, and outcome. Results The 49 ELBW infants had a mean birth weight of (892±83) g and a mean gestational age of (28.2±2.3) weeks. There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), grade Ⅲ BPD, sepsis, and pneumonia (P > 0.05). There was also no significant difference in the duration of parenteral nutrition, the age of total enteral nutrition, and head circumference/body length/body weight at discharge between the two groups (P > 0.05). Of all the infants, 22 (45%) had parenteral nutrition-associated cholestasis (PNAC), with 13 (50%) in the SMOF group and 9 (39%) in the MCT/LCT group but there was no significant difference in the incidence of PNAC between the two groups (P > 0.05); however, the infants with PNAC in the SMOF group had significantly lower peak values of direct bilirubin and alanine aminotransferase than those in the MCT/LCT group (P < 0.05). Conclusions The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications, but compared with MCT/LCT emulsion, SMOF can reduce the severity of PNAC in ELBW infants.
LIN Hui-Jia,SHEN Xiao-Xia,NI Ying-Hua et al. Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants[J]. CJCP, 2021, 23(3): 229-235.
Fallon EM, Le HD, Puder M. Prevention of parenteral nutrition-associated liver disease:role of omega-3 fish oil[J]. Curr Opin Organ Transplant, 2010, 15(3):334-340.
[2]
Calder PC, Jensen GL, Koletzko BV, et al. Lipid emulsions in parenteral nutrition of intensive care patients:current thinking and future directions[J]. Intensive Care Med, 2010, 36(5):735-749.
[3]
邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京:人民卫生出版社, 2011.
[4]
Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants?[J]. Congenit Heart Dis, 2019, 14(1):21-26.
[5]
Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates[J]. JAMA Pediatr, 2015, 169(9):863-872.
[6]
Higgins RD, Jobe AH, Koso-Thomas M, et al. Broncho-pulmonary dysplasia:executive summary of a workshop[J]. J Pediatr, 2018, 197:300-308.
[7]
Lauriti G, Zani A, Aufieri R, et al. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in infants and children:a systematic review[J]. JPEN J Parenter Enteral Nutr, 2014, 38(1):70-85.
de Meijer VE, Gura KM, Le HD, et al. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associated liver disease:the Boston experience[J]. JPEN J Parenter Enteral Nutr, 2009, 33(5):541-547.
[11]
Kelly DA. Preventing parenteral nutrition liver disease[J]. Early Hum Dev, 2010, 86(11):683-687.
[12]
Ng K, Stoll B, Chacko S, et al. Vitamin E in new-generation lipid emulsions protects against parenteral nutrition-associated liver disease in parenteral nutrition-fed preterm pigs[J]. JPEN J Parenter Enteral Nutr, 2016, 40(5):656-671.
[13]
Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease[J]. Pediatrics, 2008, 121(3):e678-e686.
[14]
Torgalkar R, Dave S, Shah J, et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates:a pre-post comparative study[J]. J Perinatol, 2019, 39(8):1118-1124.
[15]
Skouroliakou M, Konstantinou D, Agakidis C, et al. Cholestasis, bronchopulmonary dysplasia, and lipid profile in preterm infants receiving MCT/ω-3-PUFA-containing or soybean-based lipid emulsions[J]. Nutr Clin Pract, 2012, 27(6):817-824.
[16]
Repa A, Binder C, Thanhaeuser M, et al. A mixed lipid emulsion for prevention of parenteral nutrition associated cholestasis in extremely low birth weight infants:a randomized clinical trial[J]. J Pediatr, 2018, 194:87-93.e1.
[17]
Kapoor V, Malviya MN, Soll R. Lipid emulsions for parenterally fed preterm infants[J]. Cochrane Database Syst Rev, 2019, 6(6):CD013163.
[18]
Lee HH, Jung JM, Nam SH, et al. Risk factor analysis of parenteral nutrition-associated cholestasis in extremely low birth weight infants[J]. Acta Paediatr, 2016, 105(7):e313-e319.
[19]
Hwang JH, Chung ML. Predictive value of the aspartate aminotransferase to platelet ratio index for parenteral nutrition associated cholestasis in extremely low birth weight infants[J]. BMC Pediatr, 2019, 19(1):126.
[20]
Kasirer Y, Bin-Nun A, Raveh A, et al. SMOFlipid protects preterm neonates against perinatal nutrition-associated cholestasis[J]. Am J Perinatol, 2019, 36(13):1382-1386.
[21]
Lin HJ, Du LZ, Ma XL, et al. Mortality and morbidity of extremely low birth weight infants in the mainland of China:a multi-center study[J]. Chin Med J (Engl), 2015, 128(20):2743-2750.
[22]
Smith LE. Through the eyes of a child:understanding retinopathy through ROP the Friedenwald lecture[J]. Invest Ophthalmol Vis Sci, 2008, 49(12):5177-5182.
[23]
Beken S, Dilli D, Fettah ND, et al. The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants:a randomized controlled trial[J]. Early Hum Dev, 2014, 90(1):27-31.
[24]
Pawlik D, Lauterbach R, Walczak M, et al. Fish-oil fat emulsion supplementation reduces the risk of retinopathy in very low birth weight infants:a prospective, randomized study[J]. JPEN J Parenter Enteral Nutr, 2014, 38(6):711-716.
[25]
Thébaud B, Goss KN, Laughon M, et al. Bronchopulmonary dysplasia[J]. Nat Rev Dis Primers, 2019, 5(1):78.
[26]
Hwang JS, Rehan VK. Recent advances in bronchopulmonary dysplasia:pathophysiology, prevention, and treatment[J]. Lung, 2018, 196(2):129-138.
