Incidence of Complications Associated with Parenteral Nutrition in Preterm Infants < 32 Weeks with a Mixed Oil Lipid Emulsion vs a Soybean Oil Lipid Emulsion in a Level IV Neonatal Intensive Care Unit

Abstract

Background Parenteral nutrition (PN) is crucial for the improvement of long‐term outcomes in very low birth weight (VLBW) neonates. Lipid injectable emulsions are a key component of PN, as they contain essential fatty acids and provide energy critical for brain growth. Prolonged administration increases risk of intestinal failure‐associated liver disease, including cholestasis, and other complications. Methods This is a retrospective, quasi‐experimental cohort study of 215 VLBW neonates. The primary outcome was a change in direct bilirubin concentration. Secondary outcomes included change in total bilirubin concentration and incidences of cholestasis and other disease states associated with PN and prematurity. Cholestasis was defined as direct bilirubin ≥ 1.0 mg/dL with total bilirubin < 5.0 mg/dL or direct bilirubin > 20% of total bilirubin with total bilirubin > 5.0 mg/dL. Results Change in direct bilirubin concentration was not different between groups. Incidence of cholestasis was not different between groups per charted diagnosis or per study definition. Non‐stage‐0 retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, and necrotizing enterocolitis were all lower in the mixed oil lipid emulsion group, which remained significant after adjustment for differences in gestational age, birth weight, and PN duration. Conclusions Although mixed oil lipid emulsion was not found to be associated with a lower risk of cholestasis, it may decrease risks of other disease states associated with PN therapy.

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

“…However, only one randomized controlled trial showed that cholestasis was significantly lower in fish oil–containing ILEs (0% vs 18.2%; P = 0.011) in VLBW infants than in the pure soybean oil emulsion 23 . Recently, published retrospective studies showed that there was no significant difference in the incidence of PNAC in VLBW infants between SMOFlipid and Intralipid, 15,24–26 which is consistent with the conclusions drawn in this study. In the current study, which reported the incidence of cholestasis, no further comparisons were made between the two ILEs in VLBW infants.…”

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

“…However, they did not focus on VLBW and ELBW infants. More recently, original studies including observational studies [ 32 – 39 ] and RCTs [ 19 – 29 ] have begun to focus on the prevention effect of fish oil-containing lipid emulsions on VLBW infants, but their results vary. Our meta-analysis provides an objective argument that fish-oil containing lipid emulsions can decrease occurrence of PNAC in VLBW infants.…”

Comparison of catheter‐related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil‐based intravenous fat emulsion versus a mixed oil fat emulsion

“…Aside from literature in adult patients, a recent report examined differences in the incidence of varied complications associated with MO‐IFE versus SO‐IFE in NICU patients 37 . Of these, the incidence of sepsis was reduced in patients who received MO‐IFE compared to SO‐IFE.…”