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Growth of Head Circumference and Body Length in Preterm Infants Receiving a Multicomponent vs a Soybean-Based Lipid
Simonetta Costa1, Carmen Cocca1, Giovanni Barone2
1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, A, Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
A new multicomponent lipid emulsion (MLE) in parenteral nutrition improved head circumference and length z-scores in very low-birth-weight infants compared to traditional soybean-based lipid emulsion (SLE). This supports MLE for better infant growth outcomes.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Research
Background:
- Very low-birth-weight (VLBW) infants often experience extrauterine growth restriction despite parenteral nutrition (PN).
- Traditional soybean-based lipid emulsion (SLE) may not adequately support brain growth in VLBW infants.
- A multicomponent lipid emulsion (MLE) offers enhanced fat delivery for improved growth and neurological outcomes.
Purpose of the Study:
- To evaluate the efficacy of MLE compared to SLE in PN for VLBW infants.
- To determine if MLE reduces the loss of head circumference (HC) z-score from birth to 36 weeks' postmenstrual age (PMA) or discharge.
- To assess the impact of MLE on weight and length z-scores and other clinical outcomes.
Main Methods:
- A randomized controlled trial involving VLBW infants (BW ≤1250 g) without malformations or chromosomal abnormalities.
- Infants were randomly assigned to receive either MLE or SLE as part of their PN.
- Primary outcome: change in HC z-score; Secondary outcomes: changes in weight and length z-scores, incidence of late-onset sepsis and PN-associated cholestasis (PNAC).
Main Results:
- The study analyzed 51 infants in the MLE group and 50 in the SLE group.
- MLE was significantly associated with a decreased loss in head circumference (HC) z-scores.
- MLE also showed a significant association with a decreased loss in length z-scores.
Conclusions:
- This is the first randomized controlled trial demonstrating improved HC growth with MLE compared to pure SLE.
- MLE in PN is associated with better head circumference growth in VLBW infants.
- Findings suggest MLE may be a superior option for supporting growth in VLBW infants receiving PN.
Background:
The growth of very low-birth-weight (VLBW) infants relies, to a large extent, on parenteral nutrition (PN) during the early weeks of life. Despite the parenteral nutrients supply, extrauterine growth restriction remains the main concern for these infants. A parenteral multicomponent lipid emulsion (MLE) might improve growth and neurological outcomes, delivering fats for brain growth that the traditional soybean-based lipid emulsion (SLE) fails to provide. We hypothesize that the use of an MLE in PN may reduce the loss of head circumference (HC) z-score from birth to 36 weeks' postmenstrual age (PMA) or at discharge compared with the use of an SLE in VLBW infants.
Methods:
Infants with BW ≤1250 g, without malformations or chromosomal abnormalities, were randomly assigned to receive an MLE or an SLE. The primary outcome was the change in HC z-score (HC Δ z-score) from birth to 36 weeks' PMA or at discharge. Secondary outcomes included the change in weight and length z-score (W Δ z-score and L Δ z-score) as well as incidence of late-onset sepsis and PN-associated cholestasis (PNAC).
Results:
Of the 128 infants randomized, 51 infants in the MLE group and 50 infants in the SLE group were analyzed. The MLE was significantly associated with a decreased loss in HC and length z-scores from birth to 36 weeks' PMA or at discharge.
Conclusions:
This is the first randomized controlled trial providing the evidence that an MLE is associated with improved HC growth in comparison with a pure SLE.
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