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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks' gestation) neonates: a
Girish C Deshpande1, Karen Simmer, Trevor Mori
1Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia. girish.deshpande@health.wa.gov.au
Insights
New olive oil-based emulsions are safe for preterm infants, maintaining essential fatty acids without increasing oxidative stress. Further large trials are recommended to confirm these findings in neonatal nutrition.
Area of Science:
- Neonatal Nutrition
- Lipid Emulsions
- Oxidative Stress
Background:
- New olive oil-based (OL) lipid emulsions feature lower polyunsaturated fatty acid (PUFA) content and higher vitamin E compared to traditional soybean oil (SO) emulsions.
- This composition may offer advantages in managing oxidative stress in vulnerable populations.
Purpose of the Study:
- To compare the efficacy and safety of OL versus SO lipid emulsions in preterm neonates (<28 weeks gestation).
- To assess the impact on oxidative stress markers and fatty acid profiles in this high-risk group.
Main Methods:
- A randomized controlled trial involving preterm neonates (23-<28 weeks) receiving either OL or SO emulsion for 5 days.
- Measurements included plasma F2-isoprostanes (lipid peroxidation), plasma and red blood cell fatty acids, and liver function tests.
- Investigational blinding and a standardized protocol were employed.
Main Results:
- Both OL and SO emulsions were well-tolerated with no significant adverse events.
- Plasma F2-isoprostane levels remained comparable between groups, indicating similar lipid peroxidation.
- Despite lower PUFA content in OL, similar long-chain PUFA levels were achieved, with evidence suggesting Delta6-desaturase enzyme inhibition in the SO group.
Conclusions:
- Olive oil-based lipid emulsion is a safe and well-tolerated alternative for preterm neonates.
- It supports adequate long-chain PUFA levels without increasing oxidative stress.
- Larger clinical trials are necessary to validate these preliminary findings.
Background:
: New olive oil-based (OL) lipid emulsions (olive:soy oil = 4:1) have lower polyunsaturated fatty acid (PUFA) (20% vs 60%) and higher vitamin E content (an antioxidant) compared with traditional soybean oil (SO) emulsions.
Objective:
: Compare efficacy and safety of OL with SO emulsions in preterm neonates (<28 weeks) at high risk for oxidative stress.
Patients And Methods:
: Preterm neonates (gestation 23-<28 weeks) were randomised to receive OL or SO emulsion for 5 days using a standard protocol in a tertiary perinatal centre (King Edward Memorial Hospital for Women, Perth, Western Australia). Investigators and outcome assessors were masked to allocation. Plasma F2-isoprostanes (lipid peroxidation marker), plasma, and red blood cell fatty acids were measured before and after the study. Safety was monitored by liver function tests.
Results:
: Forty-four of 50 participants (OL-23, SO-21) completed the study. Both emulsions were well tolerated with no significant adverse events. F2-isoprostane levels were comparable at baseline and study end. Oleic and linoleic acid levels were significantly high on day 6 in OL and SO groups, respectively. Long-chain PUFA levels were similar between groups despite the lower PUFA content of OL. The olive oil-based group had significantly higher levels of C18:4n-3, suggesting Delta6-desaturase enzyme inhibition in the SO group.
Conclusions:
: Olive oil-based emulsion was safe and well tolerated by preterm neonates. Similar long-chain PUFA levels were achieved in the OL group despite significantly lower amount of PUFA content; however, there was no difference in lipid peroxidation (F2-isoprostane levels). Large trials are needed to confirm these benefits.
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