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A Comparative Study of the Effects of Lipid Formulations on Retinopathy of Prematurity
Afeez K Adisa1, Mahmoud Ali1,2, Marwa M Elgendy1,3
1MetroHealth Medical Center, Case Western Reserve University, Department of Pediatrics, Neonatal Intensive Care Unit. Cleveland, Ohio, USA.
Insights
SMOFlipid, an omega-3 rich lipid emulsion, did not significantly alter Retinopathy of Prematurity (ROP) incidence or severity compared to Intralipid in very low birth weight infants. However, SMOFlipid was associated with increased rates of severe ROP.
Area of Science:
- Neonatalogy
- Ophthalmology
- Nutritional Science
Background:
- Retinopathy of Prematurity (ROP) is a leading cause of visual impairment in premature infants.
- Omega-3 fatty acids, found in fish oil and SMOFlipid, possess properties that may reduce ROP risk.
- SMOFlipid, a lipid emulsion rich in omega-3 polyunsaturated fatty acids (PUFAs), was investigated for its potential to prevent ROP.
Purpose of the Study:
- To compare the incidence and severity of Retinopathy of Prematurity (ROP) in preterm infants receiving Intralipid versus SMOFlipid.
- To evaluate the role of SMOFlipid, a lipid emulsion, in the context of ROP development and progression.
Main Methods:
- A retrospective cohort study involving 493 preterm infants with very low birth weight (VLBW) born before 30 weeks gestational age.
- Infants received either Intralipid or SMOFlipid and were monitored for ROP development and severity.
- Data collected included gestational age, birth weight, and various clinical factors associated with ROP.
Main Results:
- No significant difference in ROP incidence (41.8% vs. 37.1%) or severity was observed between the Intralipid and SMOFlipid groups.
- The SMOFlipid group exhibited significantly higher rates of severe ROP (Plus disease).
- Independent predictors of ROP included gestational age, birth weight, steroid use, lipid exposure duration, and comorbidities like sepsis and BPD.
Conclusions:
- SMOFlipid's impact on ROP incidence and severity is comparable to traditional soy-based lipid emulsions (Intralipid).
- Despite its omega-3 content, SMOFlipid did not demonstrate a preventive effect on ROP and was associated with increased severe disease.
- Further research is needed to understand factors influencing severe ROP and the role of specific lipid formulations.
Introduction:
Retinopathy of Prematurity (ROP) is the leading cause of visual morbidity in premature infants. Omega-3 PUFA concentrated in fish oil has been shown to reduce ROP risk through its anti-ischemic, anti-inflammatory, and antioxidant properties. The SMOFlipid formulation is a rich omega‑3 source and may reduce ROP risk. We aimed to compare the ROP incidence and severity in preterm VLBW (<1501 g) infants receiving Intralipid versus SMOFlipid.
Methods:
In a single-center, retrospective cohort study, we enrolled 493 preterm VLBW infants born between 2014 and 2022 at < 30 weeks GA and /or <1501g, who received either Intralipid or SMOFlipid, and were examined for ROP.
Results:
There was no difference between the Intralipid and the SMOFlipid groups in the incidence of ROP (41.8% versus 37.1%, P=0.291) and its severity (P=0.313). Still, the SMOFlipid group had significantly higher rates of Plus (+) disease (P<0.001). Gestational age, birth weight, mode of delivery, use of steroids, length of lipid use, use of inotropes, hyperglycemia requiring insulin, and length of hospitalization were independent predictors of ROP. PDA, sepsis, NEC, BPD, and IVH were also independently associated with ROP on multivariate analysis.
Discussion:
The study groups were comparable. Despite its omega‑3 content, evidence on SMOFlipid's effect on ROP remains inconsistent. The increased risk of disease suggests other unmeasured factors may influence severe ROP. As the largest study comparing IL and SMOFlipid, the preventive effect of SMOFlipid remains uncertain.
Conclusion:
The impact of SMOFlipid on the incidence and severity of ROP is comparable to that of soy-based lipid emulsions.
