Inpatient outcomes of preterm infants receiving ω-3 enriched lipid emulsion (SMOFlipid): an observational study
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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.
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.
KeywordsParenteral nutrition Liver disease Intralipid Bronchopulmonary dysplasia
Intrauterine growth restriction
Long-chain polyunsaturated fatty acids
Medium chain triglycerides
Neonatal intensive care unit
Premature rupture of membranes
Retinopathy of prematurity
Total parenteral nutrition
The authors wish to thank Ms. Megan Williams, Pharmacist, Monash Health.
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
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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