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Ikeda N, Shepherd E, Makrides M, McPhee AJ, Gibson RA, Gould JF. The effects of parenteral fish oil on neurodevelopment in preterm infants: A narrative review. Prostaglandins Leukot Essent Fatty Acids 2024; 201:102620. [PMID: 38763084 DOI: 10.1016/j.plefa.2024.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE This narrative review aimed to summarize studies assessing the effects of parenteral fish oil on neurodevelopment in preterm infants. METHODS PubMed was searched (July 1985 to October 2023). We reviewed randomized controlled trials, and observational studies assessing intravenous lipid emulsion with fish oil in preterm infants (born less than 37 weeks' gestation), that reported long-term neurodevelopmental outcomes. RESULTS We identified four publications relating to three randomized controlled trials in addition to four cohort studies. Study designs and outcomes were heterogenous and precluded meta-analyses. Results of trials were null for a selection of neurodevelopmental outcomes, however possible benefits of parenteral fish oil supplementation for neurodevelopment was reported in three cohort studies. Certainty of the evidence is hindered by methodological limitations of available trials and observational studies. CONCLUSIONS Further research is required to firmly establish the effects of parenteral fish oil on preterm neurodevelopment.
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Affiliation(s)
- N Ikeda
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - E Shepherd
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - M Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - A J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - R A Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Li X, Chen L, Lv HF, Zhao R, Ying MF, Wei L, Zhang Y, Jiang Z. Association between two different lipid injectable emulsions and parenteral nutrition-associated cholestasis in very low birth weight infants: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:345-353. [PMID: 38062851 DOI: 10.1002/jpen.2588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Using soybean oil-based lipid emulsions (Intralipid), which contain higher amounts of ω-6 fatty acids and phytosterols in parenteral nutrition, is a risk factor for cholestasis (parenteral nutrition-associated cholestasis [PNAC]). An alternative form of a mixed lipid emulsion (SMOFlipid) has been developed to reduce the risk of PNAC, but significant benefits over Intralipid in very low birth weight (VLBW) infants have yet to be demonstrated. The aim of this study was to compare the differences in PNAC incidence in VLBW infants receiving SMOFlipid vs Intralipid. METHODS The study was conducted in Sir Run Run Shaw Hospital of the Zhejiang University School of Medicine, Hangzhou, China, from January 2016 to March 2022. In total, 235 VLBW infants were administered SMOFlipid or Intralipid for ≥21 days and were included in the study. The primary outcome was the incidence of PNAC. Secondary outcomes included bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, late-onset sepsis, length of stay, weight 28 days after birth, severity of PNAC, and the time to reversal of PNAC. RESULTS Forty-four VLBW infants (35.5%) in the SMOFlipid group vs 41 (36.9%) in the Intralipid group achieved PNAC (P = 0.817). The subgroup analysis showed that the peak direct bilirubin level was lower (median [interquartile range] 55.6 [36.4] vs 118.4 [77.2] μmol/L; P < 0.001), and the time to reversal of PNAC was shorter (44 [49] vs 96 [61]; P < 0.001) in the SMOFlipid group than in the Intralipid group. CONCLUSION SMOFlipid may represent a better alternative for VLBW infants who require prolonged parenteral nutrition.
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Affiliation(s)
- Xing Li
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Ling Chen
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai-Feng Lv
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Rui Zhao
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Miao-Fa Ying
- Department of Pharmacy, Qiantang Campus, Sir Run Run Shaw Hospital, College of Medicine, Hangzhou Qiantang Hospital, Zhejiang University, Hangzhou, China
| | - Li Wei
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ye Zhang
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Jiang
- Department of Neonatal Intensive Care Unit, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Zhang ZX, Yang Q, Shen W, Song SY, Yang D, Song SR, Zhang YJ, Xie JB, Tang LX, Kong J, Bai RM, Yu WT, Zhang J, Tong XM, Wu F, Li ZK, Mao J, Lin XZ. Effect of SMOF lipid emulsion on physical growth and extrauterine growth retardation in very preterm infants: Insights from a multicenter retrospective cohort study. Nutrition 2023; 116:112221. [PMID: 37832169 DOI: 10.1016/j.nut.2023.112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of soybean, medium-chain triacylglycerols (MCTs), olive oil, and fish oil (SMOF) on short-term clinical outcomes, physical growth, and extrauterine growth retardation (EUGR) in very preterm infants. METHODS This was a multicenter retrospective cohort study of very preterm infants hospitalized in neonatal intensive care units at five tertiary hospitals in China between January 2021 and December 2021. According to the type of fat emulsion used in parenteral nutrition (PN), eligible very preterm infants were divided into the MCTs/long-chain triacylglycerol (MCT/LCT) group and SMOF group. Change in weight z-score (weight Δz) between measurements at birth and at 36 wk of postmenstrual age or at discharge, the incidence of EUGR, and short-term clinical outcomes between the two groups were compared and analyzed. RESULTS We enrolled 409 very preterm infants, including 205 in the MCT/LCT group and 204 in the SMOF group. Univariate analysis showed that infants in the SMOF group had significantly longer duration of invasive mechanical ventilation and PN, longer days to reach total enteral nutrition, and a higher proportion of maximum weight loss than those in MCT/LCT group (all P < 0.05). After adjusting for the confounding variables, multifactorial logistic regression analysis of short-term clinical outcomes showed that SMOF had protective effects on PN-associated cholestasis (odds ratio [OR], 0.470; 95% confidence interval [CI], 0.266-0.831) and metabolic bone disease of prematurity (OR, 0.263; 95% CI, 0.078-0.880). Additionally, SMOF was an independent risk factor for lower weight growth velocity (β = -0.733; 95% CI, -1.452 to -0.015) but had no effect on the incidence of EUGR (OR, 1.567; 95% CI, 0.912 to -2.693). CONCLUSION Compared with MCT/LCT, SMOF can reduce the risk for PN-associated cholestasis and metabolic bone disease of prematurity in very preterm infants and has a negative effect on growth velocity but has no effect on the incidence of EUGR.
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Affiliation(s)
- Zhu-Xin Zhang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Qing Yang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Si-Yu Song
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dong Yang
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Shi-Rong Song
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi-Jia Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Jiang-Biao Xie
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China
| | - Juan Kong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui-Miao Bai
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Wen-Ting Yu
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Juan Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhan-Kui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xian, Shanxi, China
| | - Jian Mao
- Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory Of Perinatal-Neonatal Infection, Xiamen, China; Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, China.
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Garg PM, Pittman I, Yi J, Weis VG, Rodriguez RJ, Ladd MR, Rauh JL, McDonald AG, Welch C, Premkumar MH, Garg PP, Maheshwari A. Clinical Correlates of Cholestasis in Preterm Infants with Surgical Necrotizing Enterocolitis. NEWBORN (CLARKSVILLE, MD.) 2023; 2:191-197. [PMID: 37974929 PMCID: PMC10653206 DOI: 10.5005/jp-journals-11002-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Background We sought to investigate the clinical determinants and outcomes of cholestasis in preterm infants with surgical necrotizing enterocolitis (sNEC). Methods Retrospective comparison of clinical information in preterm infants who developed cholestasis vs those who did not. Results Sixty-two (62/91, 68.1%) infants with NEC developed cholestasis at any time following the onset of illness. Cholestasis was seen more frequently in those who had received ionotropic support at 24 hours following sNEC diagnosis (87.1% vs 58.6%; p = 0.002), had higher mean C-reactive protein levels 2 weeks after NEC diagnosis (p = 0.009), had blood culture-positive sepsis [25 (40.3%) vs 4 (13.8%); p = 0.011], received parenteral nutrition (PN) for longer durations (108.4 ± 56.63 days vs 97.56 ± 56.05 days; p = 0.007), had higher weight-for-length z scores at 36 weeks' postmenstrual age [-1.0 (-1.73, -0.12) vs -1.32 (-1.76, -0.76); p = 0.025], had a longer length of hospital stay (153.7 ± 77.57 days vs 112.51 ± 85.22 days; p = 0.024), had intestinal failure more often (61% vs 25.0%, p = 0.003), had more surgical complications (50% vs 27.6%; p = 0.044), and had >1 complication (21% vs 3.4%; p = 0.031). Using linear regression, the number of days after surgery when feeds could be started [OR 15.4; confidence interval (CI) 3.71, 27.13; p = 0.009] and the postoperative ileus duration (OR 11.9, CI 1.1, 22.8; p = 0.03) were independently associated with direct bilirubin between 2 and 5 mg/dL (mild-moderate cholestasis) at 2 months of age. The duration of PN was independently associated with direct bilirubin >5 mg/dL (severe cholestasis) at 2 months of age in these patients. Conclusion Cholestasis was seen in 68% of infants following surgical NEC. The most likely contributive factors are intestinal failure and subsequent PN dependence for longer periods. Our data suggest that identification and prevention of risk factors such as sepsis and surgical complications and early feeds following NEC surgery may improve outcomes.
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Affiliation(s)
- Parvesh Mohan Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Global Newborn Society, Clarksville, Maryland, United States of America
| | - Isabella Pittman
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Joe Yi
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, NC, United States of America
| | - Victoria G Weis
- Department of Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Ricardo Jorge Rodriguez
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Mitchell R Ladd
- Department of Pediatric Surgery, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Jessica L Rauh
- Department of Pediatric Surgery, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Anna Greene McDonald
- Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Cherrie Welch
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | | | - Padma P Garg
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Akhil Maheshwari
- Global Newborn Society, Clarksville, Maryland, United States of America
- Louisiana State University Health Sciences Center – Shreveport, LA, United States of America
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Waltz P, Azzuqa A. Nutritional considerations in the neonate. Semin Pediatr Surg 2022; 31:151197. [PMID: 36038219 DOI: 10.1016/j.sempedsurg.2022.151197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Waltz
- Assistant Professor of Surgery, UPMC Childrens Hospital of Pittsburgh, USA.
| | - Abeer Azzuqa
- Associate Professor of Pediatrics, UPMC Childrens Hospital of Pittsburgh, USA
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