Lipid emulsions for parenterally fed preterm infants

Area of Science:

• Neonatology
• Clinical Nutrition
• Pediatric Gastroenterology

Background:

• Soybean oil-based lipid emulsions (S-LE) carry risks for preterm infants due to high polyunsaturated fatty acid (PUFA) and phytosterol content.
• Newer lipid emulsions (LE) from various sources are available for parenteral nutrition (PN) in preterm infants.

Purpose of the Study:

• To compare the safety and efficacy of different LE for PN in preterm infants (<37 weeks' gestation).
• To include preterm infants with surgical conditions or parenteral nutrition-associated liver disease (PNALD)/cholestasis.
• To utilize direct comparisons and pair-wise meta-analyses.

Main Methods:

• Conducted a systematic search of multiple databases (CENTRAL, MEDLINE, Embase, CINAHL, MIDRIS) and trial registries.
• Included randomized or quasi-randomized controlled studies in preterm infants up to six months of age.
• Classified LE into fish oil-containing, conventional S-LE, and alternative LE groups.

Main Results:

• Meta-analysis showed no difference in PNALD/cholestasis incidence between fish oil-LEs and non-fish oil LEs (low-quality evidence).
• Limited evidence suggested fish oil-LE might reduce cholestasis in preterm infants with PNALD/cholestasis (very low-quality evidence).
• No significant differences were found in growth, mortality, retinopathy of prematurity (ROP), or bronchopulmonary dysplasia (BPD) between LE types.

Conclusions:

• No specific LE demonstrated superiority for preventing PNALD/cholestasis, improving growth, or reducing mortality in preterm infants.
• Insufficient evidence exists to confirm advantages of fish oil-LEs in preterm infants with surgical conditions or cholestasis.
• Further large, well-designed trials are necessary to establish optimal LE composition and the role of fish oil-containing LEs.