Fish oil- and soy oil-based lipid emulsions in neonatal parenteral nutrition: a systematic review and meta-analysis

Abstract

Both FBLs and SBLs are beneficial for neonatal PN. FBLs reduce cholestasis, and SBLs reduce the duration of respiratory support.

Influence of different intravenous lipid emulsions on growth, development and laboratory and clinical outcomes in hospitalised paediatric patients: A systematic review

“…This systematic review is the first to fully explore the effects that various LEs have on a comprehensive range of growth, development, laboratory and clinical outcomes in paediatric patients ranging from preterm infants to children < years of age. The majority of studies did not find significant differences between the use of different LEs and growth, liver enzymes, plasma triglycerides, oxidative stress, blood parameters and inflammatory markers, which is consistent with the findings of four previous systematic reviews investigating the safety and possible beneficial effects of different LEs in preterm infants (n=3) and children (n=1) [8][9][10][11].…”

“…In terms of the effects of LEs on morbidity outcomes, one study showed a potential benefit of fish oil-containing blends on the incidence of cholestasis [31]. This supports the findings of the systematic review of Kotiya et al, who found significantly lowered incidence of cholestasis with fish oil blends vs soybean oil or soybean oil/olive oil blends in premature and low birth weight neonates [11]. This may in part be due to the lower concentrations of phytosterols present in fish oil blends compared with predominantly soybean oil based LEs, high levels of which have been linked with PN-associated cholestasis [51].…”

“…Two studies also showed a potential benefit of fish oil-containing blends on lowering the risk of ROP [31,45]. ROP was not an investigated outcome in three of the earlier systematic reviews [9][10][11] whilst the review of Vlaardingerbroek et al [8] predates both relevant studies [31,45]. Fish oil contains significant amounts of both EPA and DHA and the abundance of DHA in fish oil is likely to be responsible for the beneficial effect on ROP.…”

“…Typically these reviews have been limited to a small number of trials as they considered restricted patient populations and/or outcomes. Kotiya et al [11], the most recent and largest systematic review in this field, reported benefits for both fish oil-based LEs (less incidence of cholestasis) and soybean oil-based LEs (reduction in duration of respiratory support) [11]. However, the patient population was restricted to preterm neonates or neonates with low birth weight, and not all outcomes of interest were considered.…”

Impact of Parenteral Lipid Emulsion Components on Cholestatic Liver Disease in Neonates

“…However, when data is grouped for meta-analyses that have stringent exclusion criteria MO-FE has failed to show a positive effect on treatment for PNAC [57,58]. Other meta-analysis that include less stringent inclusion criteria have found a significant positive effect with MO-FE [59,60]. In the most recent Cochrane meta-analysis, eleven studies were analyzed comparing MO-FE vs. SO-LE in infants without surgical or preexisting conditions on the efficacy of cholestasis prevention [58].…”