Top

Published in:

01-05-2018 | Original Article

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

Authors: Nalin Choudhary, Kenneth Tan, Atul Malhotra

Published in: European Journal of Pediatrics | Issue 5/2018

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.

Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, Domellof M, Embleton ND, Fusch C, Genzel-Boroviczeny O, Goulet O, Kalhan SC, Kolacek S, Koletzko B, Lapillonne A, Mihatsch W, Moreno L, Neu J, Poindexter B, Puntis J, Putet G, Rigo J, Riskin A, Salle B, Sauer P, Shamir R, Szajewska H, Thureen P, Turck D, van Goudoever JB, Ziegler EE (2010) Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 50(1):85–91. https://doi.org/10.1097/MPG.0b013e3181adaee0 CrossRefPubMed

Beken S, Dilli D, Fettah ND, Kabatas EU, Zenciroglu A, Okumus N (2014) The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial. Early Hum Dev 90(1):27–31. https://doi.org/10.1016/j.earlhumdev.2013.11.002 CrossRefPubMed

Carlson SE, Werkman SH, Peeples JM, Cooke RJ, Tolley EA (1993) Arachidonic acid status correlates with first year growth in preterm infants. Proc Natl Acad Sci U S A 90(3):1073–1077CrossRefPubMedCentralPubMed

Collins CT, Gibson RA, Makrides M, McPhee AJ, Sullivan TR, Davis PG, Thio M, Simmer K, Rajadurai VS (2016) The N3RO trial: a randomised controlled trial of docosahexaenoic acid to reduce bronchopulmonary dysplasia in preterm infants < 29 weeks' gestation. BMC Pediatr 16:72. https://doi.org/10.1186/s12887-016-0611-0 CrossRefPubMedPubMedCentral

D'Ascenzo R, D'Egidio S, Angelini L, Bellagamba MP, Manna M, Pompilio A, Cogo PE, Carnielli VP (2011) Parenteral nutrition of preterm infants with a lipid emulsion containing 10% fish oil: effect on plasma lipids and long-chain polyunsaturated fatty acids. J Pediatr 159(1):33–38.e31. https://doi.org/10.1016/j.jpeds.2010.12.052 CrossRefPubMed

Deshpande G, Simmer K, Deshmukh M, Mori TA, Croft KD, Kristensen J (2014) Fish Oil (SMOFlipid) and olive oil lipid (Clinoleic) in very preterm neonates. J Pediatr Gastroenterol Nutr 58(2):177–182. https://doi.org/10.1097/mpg.0000000000000174 CrossRefPubMed

Diamond IR, Grant RC, Pencharz PB, de Silva N, Feldman BM, Fitzgerald P, Sigalet D, Dicken B, Turner J, Marchand V, Ling SC, Moore AM, Avitzur Y, Wales PW (2016) Preventing the progression of intestinal failure–associated liver disease in infants using a composite lipid emulsion: a pilot randomized controlled trial of SMOFlipid. J Parenter Enter Nutr 41(5):866–877. https://doi.org/10.1177/0148607115626921 CrossRef

Fell GL, Nandivada P, Gura KM, Puder M (2015) Intravenous lipid emulsions in parenteral nutrition. Adv Nutr (Bethesda, Md) 6(5):600–610. https://doi.org/10.3945/an.115.009084 CrossRef

Fusch C, Bauer K, Böhles HJ, Jochum F, Koletzko B, Krawinkel M, Krohn K, Mühlebach S, Working group for developing the guidelines for parenteral nutrition of The German Society for Nutritional M (2009) Neonatology/Paediatrics—Guidelines on Parenteral Nutrition, Chapter 13. GMS German Medical Science 7:Doc15. doi:https://doi.org/10.3205/000074

10.

Guthrie G, Kulkarni M, Vlaardingerbroek H, Stoll B, Ng K, Martin C, Belmont J, Hadsell D, Heird W, Newgard CB, Olutoye O, van Goudoever J, Lauridsen C, He X, Schuchman EH, Burrin D (2016) Multi-omic profiles of hepatic metabolism in TPN-fed preterm pigs administered new generation lipid emulsions. J Lipid Res 57(9):1696–1711. https://doi.org/10.1194/jlr.M069526 CrossRefPubMedPubMedCentral

11.

Hojsak I, Colomb V, Braegger C, Bronsky J, Campoy C, Domellof M, Embleton N, Fidler Mis N, Hulst JM, Indrio F, Lapillonne A, Mihatsch W, Molgaard C, van Goudoever J, Fewtrell M (2016) ESPGHAN Committee on Nutrition position paper. Intravenous lipid emulsions and risk of hepatotoxicity in infants and children: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 62(5):776–792. https://doi.org/10.1097/mpg.0000000000001121 CrossRefPubMed

12.

Huffman SL, Harika RK, Eilander A, Osendarp SJM (2011) Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review. Matern Child Nutr 7(s3):44–65. https://doi.org/10.1111/j.1740-8709.2011.00356.x CrossRefPubMedPubMedCentral

13.

Kapoor V, Glover R, Malviya MN (2015) Alternative lipid emulsions versus pure soy oil based lipid emulsions for parenterally fed preterm infants. Cochrane Database Syst Rev 12. https://doi.org/10.1002/14651858.CD009172.pub2

14.

Kelly DA (2010) Preventing parenteral nutrition liver disease. Early Hum Dev 86(11):683–687. https://doi.org/10.1016/j.earlhumdev.2010.08.012 CrossRefPubMed

15.

Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R (2005) 1. Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41(Suppl 2):S1–87CrossRefPubMed

16.

Lee EJ, Simmer K, Gibson RA (1993) Essential fatty acid deficiency in parenterally fed preterm infants. J Paediatr Child Health 29(1):51–55CrossRefPubMed

17.

Mirtallo JM, Dasta JF, Kleinschmidt KC, Varon J (2010) State of the art review: intravenous fat emulsions: current applications, safety profile, and clinical implications. Ann Pharmacother 44(4):688–700. https://doi.org/10.1345/aph.1M626 CrossRefPubMed

18.

Muhammed R, Bremner R, Protheroe S, Johnson T, Holden C, Murphy MS (2012) Resolution of parenteral nutrition-associated jaundice on changing from a soybean oil emulsion to a complex mixed-lipid emulsion. J Pediatr Gastroenterol Nutr 54(6):797–802. https://doi.org/10.1097/MPG.0b013e3182447daf CrossRefPubMed

19.

Nandivada P, Carlson SJ, Chang MI, Cowan E, Gura KM, Puder M (2013) Treatment of parenteral nutrition-associated liver disease: the role of lipid emulsions. Adv Nutr (Bethesda, Md) 4(6):711–717. https://doi.org/10.3945/an.113.004770 CrossRef

20.

Pichler J, Simchowitz V, Macdonald S, Hill S (2014) Comparison of liver function with two new/mixed intravenous lipid emulsions in children with intestinal failure. Eur J Clin Nutr 68(10):1161–1167. https://doi.org/10.1038/ejcn.2014.118 CrossRefPubMed

21.

Rayyan M, Devlieger H, Jochum F, Allegaert K (2012) Short-term use of parenteral nutrition with a lipid emulsion containing a mixture of soybean oil, olive oil, medium-chain triglycerides, and fish oil: a randomized double-blind study in preterm infants. JPEN J Parenter Enteral Nutr 36(1 Suppl):81s–94s. https://doi.org/10.1177/0148607111424411 CrossRefPubMedPubMedCentral

22.

Savini S, D'Ascenzo R, Biagetti C, Serpentini G, Pompilio A, Bartoli A, Cogo PE, Carnielli VP (2013) The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial. Am J Clin Nutr 98(2):312–318. https://doi.org/10.3945/ajcn.112.056556 CrossRefPubMed

23.

Simopoulos AP (2002) Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 21(6):495–505CrossRefPubMed

24.

Su B-H (2014) Optimizing nutrition in preterm infants. Pediatr Neonatol 55(1):5–13. https://doi.org/10.1016/j.pedneo.2013.07.003 CrossRefPubMed

25.

Szajewska H, Horvath A, Koletzko B (2006) Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. Am J Clin Nutr 83(6):1337–1344CrossRefPubMed

26.

Taylor JE, McDonald SJ, Earnest A, Buttery J, Fusinato B, Hovenden S, Wallace A, Tan K (2017) A quality improvement initiative to reduce central line infection in neonates using checklists. Eur J Pediatr 176(5):639–646. https://doi.org/10.1007/s00431-017-2888-x CrossRefPubMed

27.

Uauy R, Hoffman DR (2000) Essential fat requirements of preterm infants. Am J Clin Nutr 71(1 Suppl):245s–250sCrossRefPubMed

28.

Uthaya S, Liu X, Babalis D, Dore CJ, Warwick J, Bell J, Thomas L, Ashby D, Durighel G, Ederies A, Yanez-Lopez M, Modi N (2016) Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition. Am J Clin Nutr 103(6):1443–1452. https://doi.org/10.3945/ajcn.115.125138 CrossRefPubMedPubMedCentral

29.

Vlaardingerbroek H, Vermeulen MJ, Carnielli VP, Vaz FM, van den Akker CH, van Goudoever JB (2014) Growth and fatty acid profiles of VLBW infants receiving a multicomponent lipid emulsion from birth. J Pediatr Gastroenterol Nutr 58(4):417–427. https://doi.org/10.1097/mpg.0000000000000280 CrossRefPubMed

30.

Waitzberg DL, Torrinhas RS, Jacintho TM (2006) New parenteral lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr 30(4):351–367CrossRefPubMed

31.

Wanten GJ, Calder PC (2007) Immune modulation by parenteral lipid emulsions. Am J Clin Nutr 85(5):1171–1184CrossRefPubMed

32.

Zhao Y, Wu Y, Pei J, Chen Z, Wang Q, Xiang B (2015) Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates. J Pediatr Gastroenterol Nutr 60(6):708–716. https://doi.org/10.1097/mpg.0000000000000665 CrossRefPubMed

Title: Inpatient outcomes of preterm infants receiving ω-3 enriched lipid emulsion (SMOFlipid): an observational study
Authors: Nalin Choudhary
Kenneth Tan
Atul Malhotra
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 5/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-018-3112-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2018

Pulse oximetry findings in newborns with antenatally diagnosed congenital heart disease

Sleep disorders during childhood: a practical review

Oral health training, knowledge, attitudes and practices of primary care paediatricians: a European survey

Fitness to fly in the paediatric population, how to assess and advice

Treatment of eosinophilic esophagitis in the pediatric patient: an evidence-based approach

Predictors and outcomes of the Neonatal Oral Motor Assessment Scale (NOMAS) performance: a systematic review