Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks' gestation) neonates: a randomised controlled trial

Abstract

Background: : New olive oil-based (OL) lipid emulsions (olive:soy oil = 4:1) have lower polyunsaturated fatty acid (PUFA) (20% vs 60%) and higher vitamin E content (an antioxidant) compared with traditional soybean oil (SO) emulsions.

Objective: : Compare efficacy and safety of OL with SO emulsions in preterm neonates (<28 weeks) at high risk for oxidative stress.

Patients and methods: : Preterm neonates (gestation 23-<28 weeks) were randomised to receive OL or SO emulsion for 5 days using a standard protocol in a tertiary perinatal centre (King Edward Memorial Hospital for Women, Perth, Western Australia). Investigators and outcome assessors were masked to allocation. Plasma F2-isoprostanes (lipid peroxidation marker), plasma, and red blood cell fatty acids were measured before and after the study. Safety was monitored by liver function tests.

Results: : Forty-four of 50 participants (OL-23, SO-21) completed the study. Both emulsions were well tolerated with no significant adverse events. F2-isoprostane levels were comparable at baseline and study end. Oleic and linoleic acid levels were significantly high on day 6 in OL and SO groups, respectively. Long-chain PUFA levels were similar between groups despite the lower PUFA content of OL. The olive oil-based group had significantly higher levels of C18:4n-3, suggesting Delta6-desaturase enzyme inhibition in the SO group.

Conclusions: : Olive oil-based emulsion was safe and well tolerated by preterm neonates. Similar long-chain PUFA levels were achieved in the OL group despite significantly lower amount of PUFA content; however, there was no difference in lipid peroxidation (F2-isoprostane levels). Large trials are needed to confirm these benefits.