European Journal of Pediatrics

, Volume 177, Issue 5, pp 723–731 | Cite as

Inpatient outcomes of preterm infants receiving ω-3 enriched lipid emulsion (SMOFlipid): an observational study

  • Nalin Choudhary
  • Kenneth Tan
  • Atul MalhotraEmail author
Original Article


Neonatal units have started to switch from using conventional soy-based to alternate lipid emulsions, like SMOFlipid. SMOFlipid has been associated with an improvement in biochemical parameters and delays progression of parenteral nutrition-associated liver disease (PNALD). This retrospective epoch study aimed to compare clinically relevant neonatal outcomes in preterm infants (< 32 weeks), receiving SMOFlipid versus Intralipid. We compared clinical outcomes in two epochs—epoch 1 (Intralipid, October 2013–June 2015) versus epoch 2 (SMOFlipid, July 2015–March 2017). Primary outcome studied was mortality and rates of severe neonatal morbidities. Univariate and multivariate regression was conducted to determine risk for mortality and PNALD. A total of 222 infants (epoch 1, 123 versus epoch 2, 99) were included in the study. A higher incidence of late onset sepsis (56 versus 30%, p < 0.005) was observed in epoch 1. There was no significant difference in mortality or rates of any other severe neonatal morbidity. The type of lipid emulsion did not have a significant effect on mortality or PNALD on regression analysis.

Conclusion: Use of SMOFlipid as the primary lipid emulsion seems to have minimal effect on rates of clinically important neonatal outcomes; however, long-term effects need to be further evaluated.

What is Known:

Many neonatal units have started replacing traditional soy-based lipid formulations with SMOFlipid (ω-3 enriched lipid emulsion), as the primary lipid component in parenteral nutrition for preterm infants.

While there is evidence associating improved liver function and balanced essential fatty acid levels in infants receiving SMOFlipid, there is a lack of evidence evaluating relevant clinical outcomes in infants receiving SMOFlipid versus traditional lipid formulations.

What is New:

The influence of SMOFlipid on a series of clinical outcomes in an at-risk preterm population is presented.

SMOFlipid appears to be well tolerated in preterm infants with minimal side effects, and some growth benefits seen.


Parenteral nutrition Liver disease Intralipid Bronchopulmonary dysplasia 



Antepartum haemorrhage


Arachidonic acid


Bronchopulmonary dysplasia


Confidence interval


Docosahexaenoic acid


Eicosapentaenoic acid


Interquartile range


Intrauterine growth restriction


Intraventricular haemorrhage


Long-chain polyunsaturated fatty acids


Medium chain triglycerides


Necrotising enterocolitis


Neonatal intensive care unit


Occipitofrontal circumference


Odds ratio


Premature rupture of membranes


Retinopathy of prematurity


Standard deviation


Total parenteral nutrition



The authors wish to thank Ms. Megan Williams, Pharmacist, Monash Health.

Authors’ Contributions

NC performed the data collection and analysis, wrote the first draft and approved the final version of the manuscript. KT assisted in data analysis, critically reviewed and approved the final version of the manuscript. AM formulated the research question, critically reviewed and approved the final version of the manuscript.

Compliance with ethical standards

Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nalin Choudhary
    • 1
  • Kenneth Tan
    • 2
    • 3
    • 4
  • Atul Malhotra
    • 2
    • 3
    • 4
    Email author
  1. 1.Monash UniversityMelbourneAustralia
  2. 2.Monash Newborn, Monash Children’s HospitalMelbourneAustralia
  3. 3.The Ritchie CentreHudson Institute of Medical ResearchMelbourneAustralia
  4. 4.Department of PaediatricsMonash UniversityMelbourneAustralia

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