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Outcomes in preterm infants who received a lipid emulsion with fish oil: An observational study
Esther S Kim1, Lauren J Lee2, Tahmineh Romero3
1Department of Pediatrics, Children's Discovery and Innovation Institute, UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Insights
Fish oil (FO15) and soybean oil (SO100) emulsions did not significantly alter docosahexaenoic acid (DHA) and arachidonic acid (ARA) levels in extremely low birth weight (ELBW) infants. Growth and clinical outcomes remained unchanged between the two lipid emulsion groups.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Clinical chemistry
Background:
- 100% soybean oil emulsions (SO100) are linked to inadequate docosahexaenoic acid (DHA) and arachidonic acid (ARA) levels in extremely low birth weight (ELBW) infants.
- A multi-oil emulsion containing 15% fish oil (FO15) offers higher DHA and ARA concentrations compared to SO100.
Purpose of the Study:
- To compare clinical outcomes, specifically growth and fatty acid profiles, in ELBW infants receiving either SO100 or FO15 lipid emulsions.
Main Methods:
- Observational study of ELBW infants (2014-2019) receiving SO100 or FO15 for over 7 days.
- Erythrocyte fatty acid levels were quantified using gas chromatography/mass spectrometry.
Main Results:
- Both SO100 and FO15 groups showed declines in DHA and ARA, with no significant difference between groups.
- Weight z-score trajectories were similar between groups after adjusting for time to full feeds.
- SO100 was associated with a non-significant trend towards increased cholestasis risk (OR 3.1, P=0.059).
Conclusions:
- Despite higher DHA and ARA content, FO15 did not prevent declines in these fatty acids in ELBW infants compared to SO100.
- Growth and other clinical comorbidities were not significantly different between the SO100 and FO15 groups.
Background:
100% soybean oil emulsions (SO100) are associated with poor docosahexaenoic acid (DHA) and arachidonic acid (ARA) status in extremely low birth weight (ELBW) infants. A multi-oil emulsion with 15% fish oil (FO15) contains more DHA and ARA than SO100. This study compares clinical outcomes, namely growth and fatty acids, in ELBW infants who received S0100 or FO15.
Methods:
This observational study included ELBW infants born between 2014 and 2019 who received SO100 or FO15 for >7 days. Gas chromatography/mass spectrometry was used to measure erythrocyte fatty acids.
Results:
The mean ± SD gestational age was 27 ± 3 and 26 ± 2 weeks for SO100 (n = 43) and FO15 (n = 43), respectively (P = 0.2). DHA (-0.3 ± 0.10% per week, P = 0.026, for FO15 vs -0.2 ± 0.05% per week, P < 0.001, for SO100) and ARA (-0.8 ± 0.21% per week for FO15 vs -0.9 ± 0.17% per week for SO100; P < 0.001 for both) declined in both groups with no difference between groups (P interaction > 0.7 for both). After controlling for days to reach full feeds, the mean difference in weight z score trajectories was similar (Est = -0.08; 95% CI, -0.82 to 0.04; P = 0.2), and SO100 was associated with a nonsignificant increased odds for cholestasis (odds ratio, 3.1; 95% CI, 0.96-10.2; P = 0.059). There was no difference in other clinical comorbidities.
Conclusions:
In comparison with ELBW infants who received SO100, infants who received FO15 still demonstrated a decline in DHA and ARA. Growth and other clinical outcomes were unchanged.
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