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

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Abstract

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.

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Abbreviations

APH:

Antepartum haemorrhage

ARA:

Arachidonic acid

BPD:

Bronchopulmonary dysplasia

CI:

Confidence interval

DHA:

Docosahexaenoic acid

EPA:

Eicosapentaenoic acid

IQR:

Interquartile range

IUGR:

Intrauterine growth restriction

IVH:

Intraventricular haemorrhage

LCPUFA:

Long-chain polyunsaturated fatty acids

MCT:

Medium chain triglycerides

NEC:

Necrotising enterocolitis

NICU:

Neonatal intensive care unit

OFC:

Occipitofrontal circumference

OR:

Odds ratio

PROM:

Premature rupture of membranes

ROP:

Retinopathy of prematurity

SD:

Standard deviation

TPN:

Total parenteral nutrition

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Monash University, Melbourne, Australia

    Nalin Choudhary

  2. Monash Newborn, Monash Children’s Hospital, Melbourne, Australia

    Kenneth Tan & Atul Malhotra

  3. The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia

    Kenneth Tan & Atul Malhotra

  4. Department of Paediatrics, Monash University, Melbourne, Australia

    Kenneth Tan & Atul Malhotra

Authors
  1. Nalin Choudhary
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  2. Kenneth Tan
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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.

Corresponding author

Correspondence to Atul Malhotra.

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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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Communicated by Patrick Van Reempts

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Choudhary, N., Tan, K. & Malhotra, A. Inpatient outcomes of preterm infants receiving ω-3 enriched lipid emulsion (SMOFlipid): an observational study. Eur J Pediatr 177, 723–731 (2018). https://doi.org/10.1007/s00431-018-3112-3

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  • DOI: https://doi.org/10.1007/s00431-018-3112-3

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