Association between two different lipid injectable emulsions and parenteral nutrition–associated cholestasis in very low birth weight infants: A retrospective cohort study

Abstract

BackgroundUsing soybean oil‐based lipid emulsions (Intralipid), which contain higher amounts of omega‐6 fatty acids and phytosterols in parenteral nutrition, is a risk factor for cholestasis (PNAC). An alternative form of a mixed lipid emulsion (SMOFlipid) has been developed to reduce the risk of PNAC, but significant benefits over Intralipid in very low birth weight (VLBW) infants have yet to be demonstrated. The aim of this study was to compare the differences in PNAC incidence in VLBW receiving SMOFlipid vs. Intralipid.MethodsThe study was conducted in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, China, from January 2016 to March 2022. In total, 235 VLBW infants were administered SMOFlipid or Intralipid for ≥ 21 days and were included in the study. The primary outcome was the incidence of PNAC. Secondary outcomes included bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, late‐onset sepsis, length of stay, weight 28 days after birth, severity of PNAC and the time to reversal of PNAC.ResultsForty‐four VLBW infants (35.5%) in the SMOFlipid group vs. 41 (36.9%) in the Intralipid group achieved PNAC (P = 0.817). The subgroup analysis showed that the peak direct bilirubin level was lower (median [IQR] 55.6 [36.4] vs. 118.4 [77.2] μmol/L, P < 0.001) and the time to reversal of PNAC was shorter (median [IQR] 44 [49] vs. 96 [61]; P < 0.001) in the SMOFlipid group than in the Intralipid group.ConclusionsSMOFlipid may represent a better alternative for VLBW infants who require prolonged parenteral nutrition.This article is protected by copyright. All rights reserved.