SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants

Area of Science:

• Neonatalogy
• Pediatric Nutrition
• Intensive Care Medicine

Background:

• Soybean oil, medium-chain triglycerides, olive oil, and fish oil lipid emulsion (SMOFlipid) is increasingly used in neonates.
• Evidence supporting its benefits, particularly in very preterm infants, remains limited.
• Understanding its impact on growth and neonatal morbidities is crucial.

Purpose of the Study:

• To evaluate the effect of SMOFlipid compared to a soybean-based lipid emulsion on growth velocity.
• To assess the association of SMOFlipid with neonatal morbidities, including bronchopulmonary dysplasia and late-onset sepsis.
• To analyze these effects in very preterm infants.

Main Methods:

• Retrospective cohort study comparing very preterm infants receiving SMOFlipid versus a soybean-based lipid emulsion.
• Linear regression for growth velocity analysis (Δ weight z-score).
• Modified log-Poisson regression with generalized estimating equations for neonatal morbidities, adjusting for confounders.

Main Results:

• SMOFlipid was associated with significantly lower growth velocity (aMD -0.67) compared to intralipid.
• A lower rate of bronchopulmonary dysplasia (aRR 0.61) was observed with SMOFlipid.
• SMOFlipid use was linked to a higher rate of late-onset sepsis (aRR 1.44).
• Subgroup analysis showed lower growth velocity primarily in male infants receiving SMOFlipid.

Conclusions:

• SMOFlipid use in very preterm infants is associated with reduced growth velocity and lower incidence of bronchopulmonary dysplasia.
• However, it also correlates with an increased risk of late-onset sepsis, presenting a complex risk-benefit profile.
• Further research is needed to optimize lipid emulsion strategies for vulnerable preterm neonates.