Influence of Human Milk and Parenteral Lipid Emulsions on Serum Fatty Acid Profiles in Extremely Preterm Infants

Abstract

Background: Infants born prematurely are at risk of a deficiency in ω-6 and ω-3 long-chain polyunsaturated fatty acids (LC-PUFAs) arachidonic acid (AA) and docosahexaenoic acid (DHA). We investigated how fatty acids from breast milk and parenteral lipid emulsions shape serum LC-PUFA profiles in extremely preterm infants during early perinatal life.

Methods: Ninety infants born < 28 weeks gestational age were randomized to receive parenteral lipids with or without the ω-3 LC-PUFAs eicosapentaenoic acid (EPA) and DHA (SMOFlipid: Fresenius Kabi, Uppsala, Sweden, or Clinoleic: Baxter Medical AB, Kista, Sweden, respectively). The fatty acid composition of infant serum phospholipids was determined from birth to postmenstrual age 40 weeks, and in mother's milk total lipids on postnatal day 7. Enteral and parenteral intake of LC-PUFAs was correlated with levels in infant serum.

Results: Infants administered parenteral ω-3 LC-PUFAs received 4.4 and 19.3 times more DHA and EPA, respectively, over the first 2 weeks of life. Parenteral EPA but not DHA correlated with levels in infant serum. We found linear relationships between dietary EPA and DHA and infant serum levels in the Clinoleic (Baxter Medical AB) group. The volume of administered SMOFlipid (Fresenius Kabi) was inversely correlated with serum AA, whereas Clinoleic (Baxter Medical AB) inversely correlated with serum EPA and DHA.

Conclusions: There appears to be no or low correlation between the amount of DHA administered parenterally and levels measured in serum. Whether this observation reflects serum phospholipid fraction only or truly represents the amount of accreted DHA needs to be investigated. None of the parenteral lipid emulsions satisfactorily maintained high levels of both ω-6 and ω-3 LC-PUFAs in infant serum.

Keywords: arachidonic acid; docosahexaenoic acid (DHA); extremely preterm; human milk; long-chain polyunsaturated fatty acids (LC-PUFA); parenteral nutrition.

Figure 1

Patient enrollment flowchart.

Figure 2

(A) Histogram showing the number of days infants received parenteral lipid nutrition. (B) Total number of infants receiving full enteral feeding (> 150 mL kg⁻¹ d⁻¹).

Figure 3

Relationship between total intake of DHA and infant serum level on postnatal day 14. (A) Total DHA administered enterally (mother's milk and donor milk) vs infant serum in the Clinoleic (Baxter Medical AB, Kista, Sweden) group and (B) SMOFlipid (Fresenius Kabi, Uppsala, Sweden) group. (C) Total DHA administered parenterally vs infant serum levels in the SMOFlipid group (Fresenius Kabi). (D) Total DHA administered enterally and parenterally vs infant serum levels in the Clinoleic (Baxter Medical AB) and SMOFlipid (Baxter Medical AB) groups. DHA, docosahexaenoic acid.

Figure 4

Relationship between total intake of EPA and infant serum levels on postnatal day 14. (A) Total EPA administered enterally (mother's milk and donor milk) vs infant serum levels in the Clinoleic (Baxter Medical AB, Kista, Sweden) group (B) and in the SMOFlipid (Fresenius Kabi, Uppsala, Sweden) group. (C) Total EPA administered parenterally vs serum levels in the SMOFlipid (Fresenius Kabi) group. (D) Total volume of administered parenteral lipid emulsion vs infant serum EPA levels in the Clinoleic (Baxter Medical AB) group. EPA, eicosapentaenoic acid.

Figure 5

Relationship between total intake of parenteral lipid emulsion and infant serum AA levels on postnatal day 14. Total volume of administered parenteral lipid emulsion vs infant serum AA levels in the SMOFlipid (Fresenius Kabi, Uppsala, Sweden) group. AA, arachidonic acid.