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Observational Study
. 2023 Mar;47(3):354-363.
doi: 10.1002/jpen.2464. Epub 2023 Jan 7.

Outcomes in preterm infants who received a lipid emulsion with fish oil: An observational study

Esther S Kim  1 , Lauren J Lee  2 , Tahmineh Romero  3 , Kara L Calkins  1
Affiliations
Observational Study

Outcomes in preterm infants who received a lipid emulsion with fish oil: An observational study

Esther S Kim et al. JPEN J Parenter Enteral Nutr. 2023 Mar.

Abstract

Background: 100% soybean oil emulsions (SO100) are associated with poor docosahexaenoic acid (DHA) and arachidonic acid (ARA) status in extremely low birth weight (ELBW) infants. A multi-oil emulsion with 15% fish oil (FO15) contains more DHA and ARA than SO100. This study compares clinical outcomes, namely growth and fatty acids, in ELBW infants who received S0100 or FO15.

Methods: This observational study included ELBW infants born between 2014 and 2019 who received SO100 or FO15 for >7 days. Gas chromatography/mass spectrometry was used to measure erythrocyte fatty acids.

Results: The mean ± SD gestational age was 27 ± 3 and 26 ± 2 weeks for SO100 (n = 43) and FO15 (n = 43), respectively (P = 0.2). DHA (-0.3 ± 0.10% per week, P = 0.026, for FO15 vs -0.2 ± 0.05% per week, P < 0.001, for SO100) and ARA (-0.8 ± 0.21% per week for FO15 vs -0.9 ± 0.17% per week for SO100; P < 0.001 for both) declined in both groups with no difference between groups (P interaction > 0.7 for both). After controlling for days to reach full feeds, the mean difference in weight z score trajectories was similar (Est = -0.08; 95% CI, -0.82 to 0.04; P = 0.2), and SO100 was associated with a nonsignificant increased odds for cholestasis (odds ratio, 3.1; 95% CI, 0.96-10.2; P = 0.059). There was no difference in other clinical comorbidities.

Conclusions: In comparison with ELBW infants who received SO100, infants who received FO15 still demonstrated a decline in DHA and ARA. Growth and other clinical outcomes were unchanged.

Keywords: fatty acids; lipids; neonates; parenteral nutrition.

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Conflict of interest statement

Conflicts of Interest: KLC has received research support from Fresenius Kabi. KLC has served as an advisor for Fresenius Kabi, Mead Johnson, Baxter, and Prolacta. KLC serves as an institutional principal investigator, with no salary funding, for a consortium database sponsored by Mead Johnson.

Figures

Figure 1:
Figure 1:
Red blood cell membrane (RBCM) polyunsaturated fatty acids. A. Alpha-linolenic acid (ALA), B. Linoleic acid (LA), C. Docosahexaenoic acid (DHA), D. Arachidonic acid (ARA). SO100 ■, 100% soybean intravenous lipid emulsion; FO15 ●, intravenous lipid emulsion with 15% fish oil. Data are represented as a mean (standard deviation). *p<0.05 between groups at specific time points. There was no difference when rates were compared between groups using generalized mixed linear models for these fatty acids.
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