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Harrison SP, Baumgarten SF, Chollet ME, Stavik B, Bhattacharya A, Almaas R, Sullivan GJ. Parenteral nutrition emulsion inhibits CYP3A4 in an iPSC derived liver organoids testing platform. J Pediatr Gastroenterol Nutr 2024; 78:1047-1058. [PMID: 38529852 DOI: 10.1002/jpn3.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Parenteral nutrition (PN) is used for patients of varying ages with intestinal failure to supplement calories. Premature newborns with low birth weight are at a high risk for developing PN associated liver disease (PNALD) including steatosis, cholestasis, and gallbladder sludge/stones. To optimize nutrition regimens, models are required to predict PNALD. METHODS We have exploited induced pluripotent stem cell derived liver organoids to provide a testing platform for PNALD. Liver organoids mimic the developing liver and contain the different hepatic cell types. The organoids have an early postnatal maturity making them a suitable model for premature newborns. To mimic PN treatment we used medium supplemented with either clinoleic (80% olive oil/20% soybean oil) or intralipid (100% soybean oil) for 7 days. RESULTS Homogenous HNF4a staining was found in all organoids and PN treatments caused accumulation of lipids in hepatocytes. Organoids exhibited a dose dependent decrease in CYP3A4 activity and expression of hepatocyte functional genes. The lipid emulsions did not affect overall organoid viability and glucose levels had no contributory effect to the observed results. CONCLUSIONS Liver organoids could be utilized as a potential screening platform for the development of new, less hepatotoxic PN solutions. Both lipid treatments caused hepatic lipid accumulation, a significant decrease in CYP3A4 activity and a decrease in the RNA levels of both CYP3A4 and CYP1A2 in a dose dependent manner. The presence of high glucose had no additive effect, while Clinoleic at high dose, caused significant upregulation of interleukin 6 and TLR4 expression.
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Affiliation(s)
- Sean P Harrison
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Saphira F Baumgarten
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
- Hybrid Technology Hub-Center of Excellence, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Research, Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Maria E Chollet
- Research, Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Benedicte Stavik
- Research, Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Anindita Bhattacharya
- Research, Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Runar Almaas
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gareth J Sullivan
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
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Saenz de Pipaon M, Nelin LD, Gehred A, Rossholt ME, Moltu S, Van den Akker C, van Kaam AH, Sánchez A, Khashu M, Roehr CC, Carnielli V. The role of nutritional interventions in the prevention and treatment of chronic lung disease of prematurity. Pediatr Res 2024:10.1038/s41390-024-03133-3. [PMID: 38565917 DOI: 10.1038/s41390-024-03133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/20/2024] [Indexed: 04/04/2024]
Abstract
Chronic lung disease of prematurity or bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Nutrition may affect incidence and severity of BPD. In this context, the Section on Nutrition, Gastroenterology and Metabolism, the Pulmonary Section of the European Society for Paediatric Research (ESPR) and SPR have joined forces to review the current knowledge on nutritional issues related to BPD. The aim of this narrative review is to discuss the clinical implications for nutritional practice. Nutrient deficiencies may influence pathogenesis of BPD. Adequate nutrition and growth can play a crucial role in the prevention of and recovery from BPD. Optimal nutrition strategy is an important principle, especially in the early postnatal period. As optimal energy intake in infants at risk of BPD or with evolving BPD is not yet defined, further research with well-designed studies on nutritional strategies for preterm infants with BPD is urgently needed. IMPACT: Based on current evidence it seems reasonable to recommend that BPD diagnosed infants should receive an energy supply ranging from 120 to 150 Kcal/kg/d. Exclusive MOM feed with adequate fortification should be encouraged as this is associated with a significant reduction in the risk of BPD. Suboptimal nutritional delivery is often seen in preterm infants with BPD compared to controls.
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Affiliation(s)
- Miguel Saenz de Pipaon
- Department of Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain.
| | - Leif D Nelin
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alison Gehred
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Madelaine E Rossholt
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Sissel Moltu
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Chris Van den Akker
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - Anton H van Kaam
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - Ana Sánchez
- Department of Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain
| | | | - Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Virgilio Carnielli
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
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Simonato M, Ricci F, Catozzi C, Storti M, Giambelluca S, Correani A, Salomone F, Cogo P, Carnielli V. Deuterium-depleted water: A new tracer to label pulmonary surfactant lipids in adult rabbits. JOURNAL OF MASS SPECTROMETRY : JMS 2022; 57:e4808. [PMID: 35060656 PMCID: PMC9285457 DOI: 10.1002/jms.4808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Stable isotope tracing can be safely used for metabolic studies in animals and humans. The endogenous biosynthesis of lipids (lipogenesis) is a key process throughout the entire life but especially during brain and lung growth. Adequate synthesis of pulmonary surfactant lipids is indispensable for life. With this study, we report the use of deuterium-depleted water (DDW), suitable for human consumption, as metabolic precursor for lipogenesis. We studied 13 adult rabbits for 5 days. Four rabbits drank tap water (TW) and served as controls; in four animals, DDW was substituted to drinking water, whereas five drank deuterium-enriched water (DEW). After 5 days, a blood sample and a bronchoalveolar lavage (BAL) sample were collected. The 2 H/1 H (δ2 H) of BAL palmitic acid (PA) desaturated phosphatidylcholine (DSPC), the major phospholipid of pulmonary surfactant, and of plasma water was determined by high-resolution mass spectrometry. We found that the δ2 H values of DDW, DEW and TW were -984 ± 2‰, +757 ± 2‰ and -58 ± 1‰, respectively. After 5 days, plasma water values were -467 ± 87‰, +377 ± 56‰ and -53 ± 6‰, and BAL DSPC-PA was -401 ± 27‰, -96 ± 38‰ and -249 ± 9‰ in the DDW, DEW and TW, respectively. With this preliminary study, we demonstrated the feasibility of using DDW to label pulmonary surfactant lipids. This novel approach can be used in animals and in humans, and we speculate that it could be associated with more favourable study compliance than DEW in human studies.
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Affiliation(s)
- Manuela Simonato
- PCare LaboratoryFondazione Istituto di Ricerca Pediatrica, ‘Città della Speranza’PaduaItaly
- Department of Women's and Children's HealthUniversity of PaduaPaduaItaly
| | - Francesca Ricci
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Chiara Catozzi
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Matteo Storti
- Department of Chemical & Life Sciences and Environmental SustainabilityUniversity of ParmaParmaItaly
| | - Sonia Giambelluca
- PCare LaboratoryFondazione Istituto di Ricerca Pediatrica, ‘Città della Speranza’PaduaItaly
- Department of Women's and Children's HealthUniversity of PaduaPaduaItaly
| | - Alessio Correani
- Division of NeonatologyPolytechnic University of Marche and ‘G. Salesi’ Children's HospitalAnconaItaly
| | - Fabrizio Salomone
- Neonatology and Pulmonary Rare Disease Unit, Pharmacology & Toxicology Department Corporate Preclinical R&DChiesiParmaItaly
| | - Paola Cogo
- Department of Medicine, University Hospital Santa Maria della MisericordiaUniversity of UdineUdineItaly
| | - Virgilio Carnielli
- Division of NeonatologyPolytechnic University of Marche and ‘G. Salesi’ Children's HospitalAnconaItaly
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Biagetti C, Correani A, D'Ascenzo R, Ferretti E, Proietti C, Antognoli L, Giretti I, Pompilio A, Cogo P, Carnielli VP. Is intravenous fish oil associated with the neurodevelopment of extremely low birth weight preterm infants on parenteral nutrition? Clin Nutr 2021; 40:2845-2850. [PMID: 33933751 DOI: 10.1016/j.clnu.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Preterm infants are at increased risk of long-term neurodevelopmental disabilities (NDD). Long chain n-3 fatty acids play a key role during the development of the central nervous system and some studies in preterm infants showed benefits of docosahexaenoic acid and arachidonic acid supplementation for visual and cognitive development. In recent years fish oil has been added to the fat blend of intravenous (IV) lipid emulsions (LE) but to date scanty data are available on neurodevelopmental outcome of preterm infants that received fish oil containing LE. We studied the effect of fish oil containing IV LE vs standard IV LE on neurodevelopment in a large cohort of preterm infants who received routine parenteral nutrition (PN) from birth. METHODS We retrospectively reviewed the neurodevelopmental outcome of 477 preterm infants (birth weight (BW): 400-1249 g and gestational age (GA) at birth: 24+0 - 35+6 weeks (W)) admitted to our NICU between Oct-2008 and June-2017, who received routine PN with different LE, with and without fish oil (IV-FO vs CNTR). We compared neurodevelopment at 2 years corrected age by the Bayley III development scale and the incidence of NDD. RESULTS Demographics, birth data and the incidence of the main clinical short-term outcomes of prematurity were similar in the two groups (IV-FO: n = 178, GA 197 ± 14 days, BW 931 ± 182 g; CNTR: n = 192, GA 198 ± 15 days, BW 944 ± 194 g). No differences were found in maternal demographics nor in parental education between the two groups. Cognitive score was not significantly different between IV-FO and CNTR (92 ± 15 vs 93 ± 13, p = 0.5). No differences were found in motor and language scores, and in the incidence of NDD in the two groups. CONCLUSIONS Contrary to our hypothesis, the use of fish oil containing LE in a large cohort of preterm infants on routine PN did not result in better neurodevelopment. Large randomized controlled trials powered for neurodevelopment are needed to clarify the impact of the widely used fish oil containing LE on neurodevelopment of preterm infants.
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Affiliation(s)
- Chiara Biagetti
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Alessio Correani
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Rita D'Ascenzo
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Enrica Ferretti
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Cecilia Proietti
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Luca Antognoli
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Ilaria Giretti
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Adriana Pompilio
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
| | - Paola Cogo
- Department of Medicine, University Hospital S. Maria Della Misericordia, University of Udine, Piazzale Kolbe 3, 33100 Udine, Italy.
| | - Virgilio P Carnielli
- Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123 Ancona, Italy.
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Giretti I, D'Ascenzo R, Correani A, Antognoli L, Monachesi C, Biagetti C, Pompilio A, Marinelli L, Burattini I, Cogo P, Carnielli VP. Hypertriglyceridemia and lipid tolerance in preterm infants with a birth weight of less than 1250 g on routine parenteral nutrition. Clin Nutr 2021; 40:4444-4448. [PMID: 33526286 DOI: 10.1016/j.clnu.2020.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the association of hypertriglyceridemia and of lipid tolerance with clinical and nutritional data in preterm infants receiving routine parenteral nutrition. DESIGN We retrospectively studied 672 preterm infants (gestational age <32 weeks) with birth weight <1250 g, consecutively admitted to our NICU, born between 2004 and 2018. Selected prenatal data and interventions, parenteral intakes and diseases were considered. Hypertriglyceridemia was defined as plasma triglycerides >250 mg⋅dL-1. Lipid tolerance was defined as the ratio of plasma triglycerides to the intravenous lipid intake at the time of sampling. Variables associated to hypertriglyceridemia and to lipid tolerance were identified by multiple logistic and linear regression analyses. RESULTS Hypertriglyceridemia occurred in 200 preterm infants (30%), ranging from 67% at 23 weeks to 16% at 31 weeks' gestation. In 138 infants (69%) hypertriglyceridemia occurred at a lipid intake of 2.5 g⋅kg-1 or less. Lipid tolerance was reduced especially in infants of less than 28 weeks' gestation (14.3 ± 9.3 vs 18.8 ± 10.2, respectively, p < 0.001). Lipid tolerance was negatively associated with respiratory distress syndrome (OR = -1.14, p = 0.011), patent ductus arteriosus (OR = -1.73, p < 0.001), small for gestational age (OR = -2.96, p < 0.001), intraventricular haemorrhage (OR = -3.96, p < 0.001), late onset sepsis (OR = -8.56, p = 0.039). CONCLUSION Preterm infants on routine parenteral nutrition were able to tolerate markedly lower intravenous lipid intakes than the recommended target values of current guidelines. Lipid tolerance was associated with some of the major complication of prematurity, possibly at risk of developing hypertriglyceridemia.
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Affiliation(s)
- Ilaria Giretti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy.
| | - Rita D'Ascenzo
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Alessio Correani
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Luca Antognoli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy
| | - Chiara Monachesi
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy
| | - Chiara Biagetti
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Adriana Pompilio
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Luisita Marinelli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Ilaria Burattini
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Paola Cogo
- Department of Medicine, University of Udine, Udine, Italy
| | - Virgilio P Carnielli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy; Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
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Correani A, Dell'Orto V, Nobile S, Antognoli L, Marchionni P, Giretti I, Monachesi C, Rondina C, Palazzi ML, Biagetti C, D'Ascenzo R, Pompilio A, Simonato M, Cogo P, Burattini I, Carnielli VP. Oxygen saturation to fraction of inspired oxygen ratio in preterm infants on routine parenteral nutrition with conventional or fish oil containing lipid emulsions. Pediatr Pulmonol 2020; 55:2377-2382. [PMID: 32662932 DOI: 10.1002/ppul.24938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The benefits of intravenous (IV) fish oil (FO), as a source of n-3 long-chain polyunsaturated fatty acids, on lung growth in preterm infants, remain controversial. AIM To evaluate if IV FO improves lung growth in small preterm infants on routine parenteral nutrition (PN). MATERIALS AND METHODS We retrospectively reviewed prospectively collected data of preterm infants with a birth weight <1250 g who received routine PN from birth. We compared patients who received FO containing IV lipid emulsions with infants who received conventional emulsions (CNTR). The oxygen saturation (SpO2 ) to a fraction of inspired oxygen (FiO2 ) ratio (SFR) at 36 weeks (W) of gestation was chosen as the primary outcome variable to assess lung growth. RESULTS Four hundred and seventy-seven infants were studied: 240 received IV FO and 237 CNTR. While exposure to antenatal glucocorticoids was higher in IV FO group than in CNTR (95 vs 90%, P = .04), there were no differences in birth data, enteral and parenteral nutrition intakes, ventilator supports and drug therapies. The incidence of the most common complications of prematurity at 36 W was not different (bronchopulmonary dysplasia was 27 vs 21% in IV FO vs CNTR infants, P = .1). Weight gain from birth to 36 W was marginally, but significantly, higher (+0.5 g/kg/d, P = .03) in IV FO group vs CNTR. SFR increased from 32 W to 36 W in all study patients (P < .001). IV FO infants had significantly lower SpO2 from 33 W to 35 W (P < .001) and lower (worse) SFR at 36 W (432 ± 57 vs 444 ± 51, P = .026) compared to CNTR. CONCLUSION Contrary to our hypothesis, the use of FO containing IV lipid emulsions for the routine PN of the preterm infant did not improve lung growth compared to the infants who received conventional IV lipid emulsions.
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Affiliation(s)
- Alessio Correani
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Valentina Dell'Orto
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Stefano Nobile
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Luca Antognoli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Marchionni
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Ilaria Giretti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Monachesi
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Clementina Rondina
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Maria Laura Palazzi
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Chiara Biagetti
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Rita D'Ascenzo
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Adriana Pompilio
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Manuela Simonato
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica, "Città della Speranza", Padua, Italy
| | - Paola Cogo
- Department of Medicine, University of Udine, Udine, Italy
| | - Ilaria Burattini
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy
| | - Virgilio P Carnielli
- Department of Mother and Child Health, Division of Neonatology, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I, Ancona, Italy.,Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
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Hypertriglyceridemia and Intravenous Lipid Titration During Routine Parenteral Nutrition in Small Preterm Infants. J Pediatr Gastroenterol Nutr 2019; 69:619-625. [PMID: 31436699 DOI: 10.1097/mpg.0000000000002459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity, and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR). METHODS We retrospectively reviewed data of preterm infants with a birth weight (BW) <1250 g consecutively admitted to our neonatal intensive care unit (2004-2016) who received routine PN. HiTG infants were defined by at least 1 triglyceride (TG) measurement >250 mg/dL during the first 10 days of life. Patients with and without HiTG were match-paired for BW and gestational age. RESULTS A total of 658 infants were analyzed and 196 (30%) had HiTG. One hundred thirty-six HiTG patients were matched with 136 CNTR. In the first 10 days of life, IV lipid, non-protein energy and total energy intakes, but not IV amino acids and carbohydrates, were significantly lower in HiTG infants. We found no differences between groups in diseases associated with prematurity. Anthropometry at 36 weeks (W), anthropometry at 2-year (Y) corrected age (CA), and neurodevelopment at 2Y CA were not different. CONCLUSIONS Growth, diseases associated with prematurity, and neurodevelopment at 2Y CA in HiTG infants were similar to CNTR. This occurred despite a statistically significant albeit small reduction in IV lipid and non-protein energy intakes due to a strict TG monitoring and IV lipid titration at TG levels >250 mg/dL.
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Biagetti C, Correani A, D'Ascenzo R, Bellagamba MP, Marchionni P, Antognoli L, Pompilio A, Cogo P, Carnielli VP. Does intravenous fish oil affect the growth of extremely low birth weight preterm infants on parenteral nutrition? Clin Nutr 2019; 38:2319-2324. [DOI: 10.1016/j.clnu.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022]
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Abstract
BACKGROUND Conventionally used soybean oil-based lipid emulsion (S-LE) have high polyunsaturated fatty acid (PUFA) content and phytosterols that may contribute to adverse effects in preterm infants. The newer lipid emulsions (LE) from different lipid sources are currently available for use in preterm infants. OBJECTIVES To compare the safety and efficacy of all LE for parenteral nutrition (PN) in preterm infants (less than 37 weeks' gestation) including preterm infants with surgical conditions or parenteral nutrition-associated liver disease (PNALD)/cholestasis using direct comparisons and pair-wise meta-analyses. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE (1946 to 18 June 2018), Embase (1974 to 18 July 2018), CINAHL (1982 to 18 June 2018), MIDRIS (1971 to 31 May 2018), conference proceedings, trial registries (ClinicalTrials.gov and WHO's Trials Registry and Platform), and reference lists of retrieved articles. SELECTION CRITERIA Randomised or quasi-randomised controlled studies in preterm infants with or without surgical conditions or PNALD within the first six months of life. DATA COLLECTION AND ANALYSIS Data collection and analysis conformed to the methods of Cochrane Neonatal. We used the GRADE approach to assess the quality of evidence for important outcomes in addition to reporting statistical significance of results. MAIN RESULTS We included 29 studies (n = 2037) in this review. LE were classified in three broad groups: 1. all fish oil-containing LE including pure fish oil-LE (F-LE) and multisource LE (e.g. medium-chain triglycerides (MCT)-olive-fish-soybean oil-LE (MOFS-LE), MCT-fish-soybean oil-LE (MFS-LE) and olive-fish-soybean oil-LE (OFS-LE); 2. conventional S-LE; 3. alternative-LE (e.g. MCT-soybean oil-LE (MS-LE), olive-soybean oil-LE and borage oil-based LE).We considered the following broad comparisons: fish oil LE versus non-fish oil LE; fish oil LE versus another fish oil LE; alternative-LE versus S-LE; alternative-LE versus another alternative-LE in preterm infants less than 37 weeks' gestation, preterm infants with surgical conditions and preterm infants with PNALD/cholestasis. Separate subgroup comparisons of each LE preparation were included within these broader groups.Most studies in preterm infants used PN for mean duration of four weeks or less and for longer duration in infants with cholestasis or surgical conditions.We defined the primary outcome of PNALD/cholestasis as conjugated bilirubin (Cbil) 2 mg/dL or greater and resolution of PNALD/cholestasis as Cbil less than 2 mg/dL. There was heterogeneity in definitions used by the included studies with Cbil cut-offs ranging from 17.1 μmol/L (1 mg/dL) up to 50 μmol/L (about 3 mg/dL).In preterm infants, meta-analysis found no evidence of a difference in the incidence of PNALD/cholestasis (Cbil cut-off: 2 mg/dl) between fish oil-LEs and all non-fish oil LEs (typical risk ratio (RR) 0.61, 95% confidence interval (CI) 0.24 to 1.56; typical risk difference (RD) -0.03, 95% CI -0.08 to 0.02; 4 studies; n = 328; low-quality evidence).We also considered an outcome allowing for any definition of PNALD (different Cbil cutoffs). In the meta-analysis for PNALD/cholestasis, using any definition and restricted to low or unclear risk of bias studies, there was no evidence of a difference between fish oil LE and all non-fish oil LE for incidence of cholestasis (typical RR 0.80, 95% CI 0.53 to 1.21; typical RD -0.02, 95% CI -0.05 to 0.02; 10 studies; n = 1024; low-quality evidence). There was no evidence of difference in subgroup meta-analyses of individual LE types in any comparison.In preterm infants with surgical conditions or cholestasis, there was only one small study each reporting no evidence of a difference in incidence or resolution of cholestasis respectively with use of a pure F-LE versus S-LE (using a Cbil cut-off of 2 mg/dL).In preterm infants with PNALD/cholestasis (using any definition), the meta-analysis showed significantly less cholestasis with the use of fish oil-LE compared to S-LE (typical RR 0.54, 95% CI 0.32 to 0.91; typical RD -0.39, 95% CI -0.65 to -0.12; number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 9; 2 studies; n = 40; very low-quality evidence). However, this outcome had a very low number of participants from two small studies with methodological differences, one of which was terminated early, increasing the uncertainty about effect estimates.There were no differences between LE types in pair-wise meta-analyses for growth in preterm infants. There was paucity of studies in preterm infants with surgical conditions or cholestasis to perform meta-analyses for growth and most other outcomes.In the secondary outcomes for preterm infants, there was no difference between fish-oil LE and non-fish oil LE in meta-analysis for severe retinopathy of prematurity (ROP) (stage 3 or greater, or requiring surgery: typical RR 0.80, 95% CI 0.55 to 1.16; typical RD -0.03, 95% CI -0.07 to 0.02; 7 studies; n = 731; very low-quality evidence). There were no differences in the LE types in pair-wise meta-analyses for death, bronchopulmonary dysplasia (BPD), ventilation duration, patent ductus arteriosus, sepsis, necrotising enterocolitis, intraventricular haemorrhage, periventricular leukomalacia, jaundice, hyperglycaemia, hypertriglyceridaemia, intrahepatocellular lipid content and conjugated bilirubin levels in any comparison.In surgical infants, one study (n = 19) reported no differences in death, sepsis rates, Cbil and neurodevelopmental outcomes with pure F-LE versus S-LE.In infants with cholestasis, there were no evidence of differences in death or sepsis in meta-analyses between fish oil-LE and S-LE; (2 studies; n = 40; very low-quality evidence). AUTHORS' CONCLUSIONS In the current review, we did not find any particular LE with or without fish oil to be better than another LE in preterm infants for prevention of PNALD/cholestasis, growth, mortality, ROP, BPD and other neonatal outcomes.In preterm infants with surgical conditions or cholestasis, there is currently insufficient evidence from randomised studies to determine with any certainty if fish oil LEs offer advantage in prevention or resolution of cholestasis or in any other clinical outcome.Further research, with larger well-designed trials, is warranted to evaluate the ideal composition of LE in preterm infants and the role of fish oil-containing and other LEs in the prevention and resolution of PNALD, ROP and other clinical outcomes.
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Affiliation(s)
- Vishal Kapoor
- Queensland Children's HospitalDepartment of Paediatrics501 Stanley StreetBrisbaneQueenslandAustralia4101
| | | | - Roger Soll
- Larner College of Medicine at the University of VermontDivision of Neonatal‐Perinatal Medicine, Department of Pediatrics111 Colchester AvenueBurlingtonVermontUSA05401
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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr 2018; 37:2324-2336. [DOI: 10.1016/j.clnu.2018.06.946] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
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