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Witte Castro A, Couce ML, de Lamas C, López-Giménez MR, Jiménez Varas MÁ, Zozaya C, Saenz de Pipaon M. Long-chain polyunsaturated fatty acids supplementation and sepsis: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03579-5. [PMID: 39300278 DOI: 10.1038/s41390-024-03579-5] [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: 12/22/2023] [Revised: 07/30/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Long chain polyunsaturated fatty acids (LCPUFAs) have proven to be essential for development in preterm infants and have been studied for their capacity to reduce inflammation and infection rates, including sepsis in enteral and parenteral nutrition. The aim of this review and meta-analysis is to gather the information available on this subject to determine if n-3 polyunsaturated fatty acids can reduce sepsis incidence in preterm infants. METHODS This systematic review was conducted by searching in the databases MEDLINE (via PubMed), ISI-Web of Science, EMBASE, SCOPUS, SciELO, and Cochrane Library databases. We analyzed the data regarding sepsis using the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence. RESULTS A total of 40 trials were included for review and 35 trials had the data available for quantitative analysis. LCPUFAs supplementation did not reduce incidence of sepsis (relative risk (RR), confidence interval (CI) 0.95 [0.87, 1.03] P = 0.87; I2 = 0%). These results remained consistent after the sensitivity analysis. CONCLUSION The results of this systematic review and meta-analysis indicate that LCPUFA supplementation is not associated with a significant decrease in the incidence of sepsis in premature infants. IMPACT Reviewing the information available about LCPUFA supplementation and sepsis since the results in previous Clinical Trials (CT) are inconclusive. It summarizes the results of 42 CT and we have not found conclusive results regarding sepsis in the literature. It could be of clinical interest for pediatricians and nutritionists.
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Affiliation(s)
| | - María L Couce
- Department of Forensic Sciences, Pathological Anatomy, Gynecology and Obstetrics and Pediatrics, University of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Neonatology, University Clinical Hospital of Santiago de Compostela, IDIS-Sanitary Research Institute of Santiago de Compostela, RICORS-SAMID, CIBERER, Santiago de Compostela, Spain
| | - Carmela de Lamas
- Department of Forensic Sciences, Pathological Anatomy, Gynecology and Obstetrics and Pediatrics, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - C Zozaya
- Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Miguel Saenz de Pipaon
- Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
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Joosten K, Vermeulen M. Principles of feeding the preterm infant. Clin Nutr ESPEN 2024; 59:320-327. [PMID: 38220393 DOI: 10.1016/j.clnesp.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Koen Joosten
- Erasmus MC-Sophia Childrens's Hospital, Department of Pediatric & Neonatal Intensive Care, Rotterdam NL.
| | - Marijn Vermeulen
- Erasmus MC-Sophia Childrens's Hospital, Department of Pediatric & Neonatal Intensive Care, Rotterdam NL
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Gabriel K, Hovater K, Gao H, de la Cruz D, Calkins KL, Neu J. Monitoring and management of hypertriglyceridemia in extremely low birth weight neonates receiving intravenous lipid emulsions: A national survey. Early Hum Dev 2023; 186:105872. [PMID: 37862901 DOI: 10.1016/j.earlhumdev.2023.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
AIM To assess the practice variation of defining, monitoring and managing hypertriglyceridemia (HTG) in extremely low birth weight neonates receiving intravenous lipid emulsions (IVLE). METHODS An 8-question survey created via the web survey site Qualtrics was distributed to neonatologists, neonatal nurse practitioners and fellows within the Section of Neonatal-Perinatal Medicine email directory list in the United States and Canada. Survey results were obtained between August and September 2022. RESULTS There were 249 respondents from approximately 4000 members within the Section of Neonatal-Perinatal Medicine. Responses were documented as a frequency (percentage) with a margin of error of plus or minus 6.2 %. Most respondents were neonatologists, individuals practicing for >10 years and reported a unit-based policy for IVLE initiation and advancement. The definitions of HTG varied among respondents, with the majority (42.7 %) reporting a defining threshold of >200 mg/dL. Nineteen percent of respondents reported not routinely monitoring serum triglyceride concentrations with variable triglyceride monitoring intervals reported by other survey respondents. Regarding elevated triglyceride concentrations, 19.0 % reported decreasing the IVLE rate and checking triglyceride concentrations until normalization; 14.6 % reported IVLE discontinuation and monitoring triglyceride concentrations until normalization; 61.9 % reported using a combination of the above practices; and 4.4 % reported individualized practices for IVLE management with elevated triglyceride concentrations. CONCLUSION This survey demonstrates a high variation in defining, monitoring and managing HTG in extremely low birth weight neonates and emphasizes the need for studies to better guide this practice.
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Affiliation(s)
- Krystina Gabriel
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States.
| | - Kylie Hovater
- Bachelor of Science Student, College of Liberal Arts and Sciences, University of Florida, 102 Griffin-Floyd Hall, Gainesville, FL 32611, United States
| | - Hanzhi Gao
- Research Design and Data Coordinating Center, Clinical and Translational Science Institute, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Diomel de la Cruz
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, United States
| | - Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States
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Haines KL, Ohnuma T, Hornik CD, Grisel B, Leraas H, Trujillo CN, Krishnamoorthy V, Raghunathan K, Wischmeyer PE. Change to Mixed-Lipid Emulsion From Soybean Oil-Based Lipid Emulsion in Pediatric Patients. JAMA Netw Open 2023; 6:e2332389. [PMID: 37669048 PMCID: PMC10481238 DOI: 10.1001/jamanetworkopen.2023.32389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Critically ill pediatric patients often require parenteral nutrition (PN) in the intensive care unit (ICU). Literature suggests mixed lipid emulsions (LE) with soybean oil reduction strategies may improve outcomes. Objective To examine the association of a hospital-wide switch to a mixed-lipid formula (4-OLE) with pediatric outcomes. Design, Setting, and Participants Retrospective cohort study at a large US academic referral center. Pediatric patients aged 1 month to 17 years requiring parenteral nutrition from May 2016 to September 2019 were included. Data were analyzed from October 2020 to February 2023. Exposure In 2017, Duke University Health System fully converted to a soybean oil/MCT/olive/fish oil lipid (4-OLE) from pure soybean oil-based LE in pediatric patients. Pediatric patients before the change (Intralipid [IL] group) were compared with patients after (4-OLE group). Main Outcomes and Measures Clinical outcomes were compared between treatment periods via multivariable regression models. The primary outcome was hospital length of stay (LOS). Fourteen secondary outcomes included hospital mortality of any cause, 30-day or 90-day readmission, pneumonia, urinary tract infections (UTIs), total caloric delivery, and liver function tests (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, and total bilirubin). Results A total of 684 children dependent on PN were identified (342 were critically ill), with 30% (206 children) in the preswitch (IL) period and 70% (478 children) in the postswitch (4-OLE) period; 123 were male (59.7%). In comparing IL vs 4-OLE, there was a significant difference in median (IQR) age (4.0 [1.2-13.0] vs 3.0 [0.8-9.0] years, respectively; P = .04), without difference in body mass index or baseline comorbidities except for significant differences in cancer diagnosis (26 patients in the IL group [12.6%] vs 29 patients in the 4-OLE group [6.1%]; P = .004) and chronic obstructive pulmonary disease (24 patients in the IL group [11.7%] vs 30 patients in the 4-OLE group [6.3%]; P = .02). In the all children cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.05-0.78), and reduced UTI risk (OR, 0.33; 95% CI, 0.18-0.64). In the ICU cohort, 4-OLE was associated with shorter hospital LOS (IRR, 0.81; 95% CI, 0.78-0.83), and reduced UTI risk (OR, 0.23; 95% CI, 0.11-0.51). Other secondary outcomes were not significant. Conclusions and Relevance In this observational study of clinical outcomes among children dependent on PN, a switch to 4-OLE in a large academic hospital was associated with a significant decrease in hospital LOS in ICU and non-ICU patients. These findings suggest switching to a soy-LE sparing strategy using 4-OLE is feasible, safe, and associated with improved clinical outcomes in pediatric PN patients.
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Affiliation(s)
- Krista L. Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
- The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina
- Departement of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Chi Dang Hornik
- Division of Pediatric Critical Care, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
- The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina
| | - Harold Leraas
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles N. Trujillo
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina
- Departement of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research Unit, Duke University Medical Center, Durham, North Carolina
- Departement of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Paul E. Wischmeyer
- Departement of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Asfour SS, Alshaikh B, AlMahmoud L, Sumaily HH, Alodhaidan NA, Alkhourmi M, Abahussain HA, Khalil TM, Albeshri BA, Alhamidi AA, Al-Anazi MR, Asfour RS, Al-Mouqdad MM. SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants. Nutrients 2022; 14:nu14193952. [PMID: 36235604 PMCID: PMC9573282 DOI: 10.3390/nu14193952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022] Open
Abstract
The soybean oil, medium-chain triglycerides, olive oil, and fish oil lipid (SMOFlipid) is increasingly being used worldwide without definite evidence of its benefits. We examined the effect of SMOFlipid on growth velocity and neonatal morbidities in very preterm infants. Very preterm infants who received soybean-based lipid emulsion between January 2015 and 2018 were compared with those who received SMOFlipids between 2019 and January 2022 in our neonatal tertiary center. Linear regression analysis was conducted to analyze the association between type of lipid emulsion and growth velocity. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber−White) were applied to adjust for potential confounding factors. A total of 858 infants met our inclusion criteria. Of them, 238 (27.7%) received SMOFlipid. SMOFlipid was associated with lower growth velocity between birth and 36-week corrected gestational age compared with intralipid Δ weight z-score (adjusted mean difference (aMD) −0.67; 95% CI −0.69, −0.39). Subgroup analysis indicated that mainly male infants in the SMOFlipid−LE group had a lower Δ weight z-score compared to those in the intralipid group (p < 0.001), with no difference observed in females (p = 0.82). SMOFlipid was associated with a lower rate of bronchopulmonary dysplasia (BPD) (aRR 0.61; 95% CI 0.46, 0.8) and higher rate of late-onset sepsis compared with intralipid (aRR 1.44; 95% CI 1.22−1.69). SMOFlipid was associated with lower growth velocity and BPD but higher rate of late-onset sepsis—it is a double-edged sword.
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Affiliation(s)
- Suzan S. Asfour
- Clinical Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Belal Alshaikh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Latifah AlMahmoud
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Haider H. Sumaily
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Nabeel A. Alodhaidan
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Mousa Alkhourmi
- Pediatric Gastroenterology Department, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Hissah A. Abahussain
- General Pediatrics Department, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Thanaa M. Khalil
- Obstetric and Gynecology Department, Maternity Hospital, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Bushra A. Albeshri
- Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Aroub A. Alhamidi
- Pharmacy Department, Pharmaceutical Care Services, Ministry of Health, Riyadh 12613, Saudi Arabia
| | - Maha R. Al-Anazi
- Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Raneem S. Asfour
- Pharmacy College, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Mountasser M. Al-Mouqdad
- Neonatal Intensive Care, Hospital of Pediatrics, King Saud Medical City, Riyadh 12746, Saudi Arabia
- Correspondence: ; Tel.: +966-114355555 (ext. 506); Fax: +966-114354406
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6
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Rao S, Simmer K. Postnatal weight gain in very preterm infants: are we aiming too high? THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:683-685. [PMID: 34450108 DOI: 10.1016/s2352-4642(21)00247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Shripada Rao
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Karen Simmer
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia.
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7
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Chan B, Lian A, Baer V, Robinson M, Ou Z, Presson AP, Zinkhan EK. An Evaluation to Establish the Acceptable Serum Triglyceride Levels in Neonates Receiving Intravenous Fat Emulsion Infusion in a Multicenter Retrospective Study. Am J Perinatol 2021; 38:e92-e101. [PMID: 32120418 PMCID: PMC10649198 DOI: 10.1055/s-0040-1705174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to establish neonatal serum triglyceride (TG) level reference ranges during lipid infusion and correlate peak TG with neonatal outcomes. STUDY DESIGN This is a retrospective review of 356 neonates with 696 TG measures obtained in four neonatal intensive care units between 2015 and 2017. TG was evaluated collectively to establish a reference range and a threshold limit. To analyze the effects of a higher TG threshold, neonates were categorized by their peak TG: <180 (TG<180), 180 to 400 (TG180-400), and > 400 mg/dL (TG>400). Univariable and multivariable regression models were constructed to compare peak TG to patient characteristic and clinical outcomes. RESULTS The frequency of TG > 400 mg/dL was 5% and found only in neonates weighing < 1.5 kg. Neonates in the TG180-400 (n = 91) group were significantly lower in birth weight and gestational age, had lower 5-minute APGAR scores, and had increased ventilatory requirement when compared with neonates in the TG<180 (n = 240) group (all p < 0.001). The TG180-400 group had increased risk of severe intraventricular hemorrhage (p = 0.02) and bronchopulmonary dysplasia (p = 0.03). Elevated TG was associated with mortality (odds ratio [OR]: 14.4, p < 0.001) in univariable analysis, but the relationship weakened (OR: 4.4, p = 0.05) after adjusting for comorbidities in multivariable logistic regression. CONCLUSION It is unclear if the adverse outcomes seen in neonates with higher peak TG were due to elevated TG alone, or whether illness severity predicted the increased TG. More prospective studies are needed to further delineate the relationships.
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Affiliation(s)
- Belinda Chan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anh Lian
- Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Vickie Baer
- Women and Newborn Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Mandy Robinson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Erin K. Zinkhan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Chen IL, Hung CH, Huang HC. Smoflipid Is Better Than Lipofundin for Long-Term Neurodevelopmental Outcomes in Preterm Infants. Nutrients 2021; 13:nu13082548. [PMID: 34444708 PMCID: PMC8398319 DOI: 10.3390/nu13082548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 01/10/2023] Open
Abstract
Neurodevelopmental morbidities developed more commonly in low-birth-weight premature infants. We sought to determine the effects of different lipid emulsions on the neurodevelopmental outcomes of children born prematurely. This retrospective cross-sectional study had two intervention legs, Lipofundin® MCT/LCT (LIPO) versus Smoflipid® (SMOF), which are mainly differentiated by fish oil. Data of premature neonates born between 2001 and 2015 from the research database of Chang Gung Memorial Hospital with corresponding individual medical records up to July 2020 were analyzed. Long-term neurodevelopmental outcomes were defined by the international classification of disease codes −9 or −10. The prevalence of diseases was compared between LIPO and SMOF groups at five and five years old and further analyzed by stratification of 1500 g birth weight. The LIPO and SMOF groups each included 1120 neonates. Epilepsy, cerebral palsy, developmental disorder and attention-deficit hyperactivity disorder (ADHD) were significantly decreased at age two years in the SMOF group, and epilepsy, language delay (LD), ADHD and autism spectrum disorder (ASD) were significantly decreased in the SMOF group at age five years. In children with birth weight < 1500 g, ADHD was decreased in the SMOF group at ages two and five years, and ASD was decreased in the SMOF group at age five years. In children with birth weight ≥ 1500 g, epilepsy, LD and ADHD were decreased in the SMOF group at age two years. LD was decreased in the SMOF group at age five years. We conclude that lipid emulsions with fish oil improve the neurodevelopmental outcomes of children born prematurely.
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Affiliation(s)
- I-Lun Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chih-Hsing Hung
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 33302, Taiwan;
| | - Hsin-Chun Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 83301, Taiwan;
- Correspondence: or
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Uberos J, Jiménez-Montilla S, Molina-Oya M, Nieto-Gómez P, Millan IC. Morbidity Outcomes of Very Low Birth Weight Neonates Receiving Parenteral Nutrition with Fish Oil Enriched Lipid Emulsion or Lipid Emulsion with Soybean Oil: An Observational Study. Am J Perinatol 2021; 38:952-959. [PMID: 31986542 DOI: 10.1055/s-0039-1701026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Intralipid (Fresenius Kabi) was the most commonly used lipid emulsion in parenteral nutrition (PN), with a 100% soybean oil composition, a low vitamin E content, and a ω-6: ω-3 ratio of 7:1. A recent alternative formulation is SMOFlipid (Fresenius Kabi), with a ω-6: ω-3 ratio of 5:2 and higher vitamin E content. A retrospective observational study was conducted to determine neonatal morbidity in very low birth weight (VLBW) premature infants during two periods: P1, when PN was based exclusively on Intralipid, and P2, when only SMOFlipid was supplied. In total, 170 VLBW neonates were analyzed, of whom 103 received PN for more than 6 days, 56 during P1, and 47 during P2. In both periods, the antenatal and neonatal characteristics of the cohort were comparable. In this analysis, the prevalence of associated comorbidities was determined. During P2, there were fewer cases of moderate to severe bronchopulmonary dysplasia (BPD) and of cholestasis, but more cases of late sepsis, mainly Staphylococcus epidermidis. No changes in the prevalence of other neonatal comorbidities were observed. We believe that the SMOFlipid used in PN could discreetly improve the prevalence of cholestasis or BPD.
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Affiliation(s)
- José Uberos
- Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain.,Medicine Faculty. Granada, Spain
| | | | - Manuel Molina-Oya
- Neonatal Intensive Care Unit, San Cecilio Clinical Hospital, Granada, Spain
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10
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Safety and Efficacy of Early High Parenteral Lipid Supplementation in Preterm Infants: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13051535. [PMID: 34063216 PMCID: PMC8147506 DOI: 10.3390/nu13051535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/02/2022] Open
Abstract
The objective of this systematic review and meta-analysis was to summarize the effects of early initiation and achievement of a high dose of parenteral lipids (≥1.5 g/kg/day reached within the first 24 h of birth) on growth and adverse outcomes in preterm infants. PubMed, EMBASE, and Cochrane databases were utilized to search for publications for this meta-analysis. Randomized controlled trials were eligible if data on growth or clinical outcome was available. The search returned nine studies. The mean proportion of postnatal weight loss (%) was lower (mean difference [MD]: −2.73; 95% confidence interval [CI]: −3.69, −1.78), and the mean head circumference near the term equivalent age (cm) was higher in the early high lipid treatment group (MD: 0.67; 95% CI: 0.25, 1.09). There was a favorable association of early high lipid administration with the incidence of extrauterine growth restriction (relative risk [RR]: 0.27; 95% CI: 0.15, 0.48). Generally, there were no differences in morbidities or adverse outcomes with early high lipid administration. Early initiation of parenteral lipids and high dose achieved within the first 24 h of life appear to be safe and endurable and offer benefits in terms of growth.
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11
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Rogulska J, Osowska S, Kunecki M, Sobocki J, Ładyżyński P, Giebułtowicz J. Antioxidant balance in plasma of patients on home parenteral nutrition: A pilot study comparing three different lipid emulsions. Clin Nutr 2021; 40:3950-3958. [PMID: 34139468 DOI: 10.1016/j.clnu.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Parenteral nutrition (PN) can supply all essential nutrients to a patient with gastrointestinal insufficiency. However, the sensitivity to lipid peroxidation might increase in those receiving PN, especially home parenteral nutrition (HPN). This study aimed to investigate whether PN affects the antioxidant balance of plasma of HPN patients without comorbidities and whether this balance is influenced by comorbidities and according to the type of lipid emulsion included in the PN. METHODS Adult patients on HPN (n = 86) received one of three types of lipid emulsion (based on 1) soyabean oil, 2) olive and soyabean oil or 3) soyabean, coconut, olive and fish oil) in all-in-one mixtures; in addition healthy controls (n = 66) were studied as comparators. HPN patients were classified to the following subgroups: 1) patients without (n = 58) or with (n = 28) comorbidities 2) patients on Intralipid (GINTRA, n = 53), ClinOleic (GCLIN, n = 17) or SMOFlipid (GSMOFn = 16). The activities of total glutathione peroxidase (GSH-Px), selenium dependent glutathione peroxidase (Se-GSHPx) and glutathione S-transferase (GST) in plasma were determined spectrophotometrically. The antioxidant potential of plasma was determined using oxygen radical absorbance capacity (ORAC). The lipid peroxidation marker malondialdehyde (MDA) was analyzed with high performance liquid chromatography. RESULTS MDA concentration was the highest in GINTRA and the lowest in GSMOF (p < 0.05). GSMOF also had the highest activity of GSH-Px. No differences in Se-GSHPx, GST and ORAC were observed among GINTRA, GCLIN and GSMOF. Comparing with healthy controls, significantly lower GST (p = 0.0293) and ORAC (p < 0.0001) were observed in the HPN patients. Among all measured parameters only the concentration of MDA was significantly higher in patients with comorbidities compared to those without them. Comorbidities did not influence MDA level in GINTRA and GSMOF being still the lowest in GSMOF (p = 0.0033). In contrast, significantly higher MDA level was observed for GCLIN in those with vs. without comorbidities (p = 0.0262). CONCLUSIONS Patients on HPN have lower antioxidant defenses than healthy controls. The type of lipid emulsion used in HPN affects lipid peroxidation (even after taking into account comorbidities which often involve oxidative stress) being the highest in GINTRA and the lowest in GSMOF. Thus, to minimize the risk of oxidative stress, SMOFlipid can be considered in patients in HPN especially for those with comorbidities. ClinOleic can be considered in HPN patients without comorbidities. The observation should be confirmed in larger studies.
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Affiliation(s)
- Joanna Rogulska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Sylwia Osowska
- Department of Clinical Pharmacy, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Marek Kunecki
- Clinical Nutrition Center, Pirogov Hospital, 191/195 Wólczańska Street, 90-001 Łódź, Poland.
| | - Jacek Sobocki
- Department of Clinical Nutrition and Surgery, Medical Center of Postgraduate Medical Education, Prof. Orłowski Hospital, 231 Czerniakowska Street, 00-416 Warsaw, Poland.
| | - Paweł Ładyżyński
- Interdisciplinary PhD Studies, Polish Academy of Sciences, 5 Jana Kazimierza Street, 01-248 Warsaw, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
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12
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Abstract
The clinical goals of intravenous lipid emulsions (ILEs) have changed since their initial development. In the past, 100% soybean oil was used to provide energy and prevent an essential fatty acid deficiency. Now, different oil sources are used with the goal of improving nutritional status and preventing common neonatal comorbidities. We now have a better understanding of specific ILE constituents, namely, fatty acids, vitamin E, and phytosterols, and how these components contribute to complications such as intestinal failure-associated liver disease. This review addresses the development and composition of different ILEs and summarizes how individual ILE ingredients affect infant metabolism and health.
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Affiliation(s)
- Kara L Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daniel T Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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13
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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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14
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Lee MS, Huang YC, Lee CH, Chen HN, Hsiao CC, Huang SC. Implementation of nutrition practice improves growth velocity and weight gain in premature infants ≤ 1250 grams. Pediatr Neonatol 2020; 61:534-541. [PMID: 32622638 DOI: 10.1016/j.pedneo.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The concept of parental nutritional care for premature infants has been applied and advanced over the past decade. This study compared the clinical outcomes before and after nutrition practice (NP) implementation and evaluated the effects of implementation on growth velocity and weight gain in premature infants. METHODS Descriptive data of premature infants (gestational age < 30 weeks; body weight ≤ 1250 g) born 4 years before and after NP implementation were retrospectively reviewed in a neonatal intensive care unit at a hospital in Taiwan. Nutrient intake, growth velocity, weight gain, and nutrition-related biochemical markers were compared at weeks 1, 2, and 4 after delivery. RESULTS A total of 77 premature infants were enrolled before NP implementation (non-NP group), whereas 89 were enrolled after implementation (NP group). The non-NP group consumed less fat and energy in week 1, and less protein, fat, and energy in weeks 2 and 4 compared with the NP group. Growth velocity was slower in the non-NP group. Fat intake was significantly positively correlated with body weight at week 4 in the non-NP group. However, protein and fat intake were significantly associated with body weight at week 1, fat and energy intakes were significantly associated with body weight at week 2, and fat intake was significantly associated with body weight at week 4 in the NP group. CONCLUSION These findings indicate that the NP implemented in this study is relatively safe and can improve growth velocity and body weight gain in premature infants.
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Affiliation(s)
- Ming-Sheng Lee
- Department of Pediatric Pulmonology and Critical Care, Changhua Christian Children Hospital, Changhua, 50050, Taiwan; Graduate Program in Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Yi-Chia Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Cheng-Han Lee
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan
| | - Hsiao-Neng Chen
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Chien-Chou Hsiao
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan; School of Medicine, Kaohsiung Medical University, 80708, Taiwan
| | - Shih-Chien Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan.
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15
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Franco S, Goriacko P, Rosen O, Morgan-Joseph T. Incidence of Complications Associated with Parenteral Nutrition in Preterm Infants < 32 Weeks with a Mixed Oil Lipid Emulsion vs a Soybean Oil Lipid Emulsion in a Level IV Neonatal Intensive Care Unit. JPEN J Parenter Enteral Nutr 2020; 45:1204-1212. [PMID: 32862507 DOI: 10.1002/jpen.2011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is crucial for the improvement of long-term outcomes in very low birth weight (VLBW) neonates. Lipid injectable emulsions are a key component of PN, as they contain essential fatty acids and provide energy critical for brain growth. Prolonged administration increases risk of intestinal failure-associated liver disease, including cholestasis, and other complications. METHODS This is a retrospective, quasi-experimental cohort study of 215 VLBW neonates. The primary outcome was a change in direct bilirubin concentration. Secondary outcomes included change in total bilirubin concentration and incidences of cholestasis and other disease states associated with PN and prematurity. Cholestasis was defined as direct bilirubin ≥ 1.0 mg/dL with total bilirubin < 5.0 mg/dL or direct bilirubin > 20% of total bilirubin with total bilirubin > 5.0 mg/dL. RESULTS Change in direct bilirubin concentration was not different between groups. Incidence of cholestasis was not different between groups per charted diagnosis or per study definition. Non-stage-0 retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, and necrotizing enterocolitis were all lower in the mixed oil lipid emulsion group, which remained significant after adjustment for differences in gestational age, birth weight, and PN duration. CONCLUSIONS Although mixed oil lipid emulsion was not found to be associated with a lower risk of cholestasis, it may decrease risks of other disease states associated with PN therapy.
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Affiliation(s)
- Susannah Franco
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.,Center for Pharmacotherapy Research and Quality, Montefiore Medical Center, Bronx, New York, USA.,Department of Pharmacy, Cone Health, Greensboro, North Carolina, USA.,SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Pavel Goriacko
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.,Center for Pharmacotherapy Research and Quality, Montefiore Medical Center, Bronx, New York, USA
| | - Orna Rosen
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Toshiba Morgan-Joseph
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.,Center for Pharmacotherapy Research and Quality, Montefiore Medical Center, Bronx, New York, USA
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16
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Beharry KD, Cai CL, Siddiqui F, D’Agrosa C, Zangaladze A, Mustafa G, Qadri A, Duggan TJ, Aranda JV. Combination Antioxidant/NSAID Therapies and Oral/Topical Ocular Delivery Modes for Prevention of Oxygen-Induced Retinopathy in a Rat Model. Nutrients 2020; 12:nu12071980. [PMID: 32635350 PMCID: PMC7400869 DOI: 10.3390/nu12071980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Given the complexity of oxygen-induced retinopathy (OIR), we tested the hypothesis that combination therapies and modes of administration would synergistically optimize efficacy for prevention of OIR. Newborn rats were exposed to neonatal intermittent hypoxia (IH) from the first day of life (P0) until P14 during which they received: (1) oral glutathione nanoparticles (nGSH) with topical ocular phosphate buffered saline (PBS); (2) nGSH with topical ocular Acuvail (ACV); (3) oral coenzyme Q10 (CoQ10) + ACV; (4) oral omega 3 polyunsaturated fatty acids (n-3 PUFAs) + ACV; (5) CoQ10 + n-3 PUFAs + PBS; or (6) CoQ10 + n-3 PUFAs + ACV. Treated groups raised in room air (RA) served as controls. At P14, pups were placed in RA with no treatment until P21. Retinal vascular pathology, ocular angiogenesis biomarkers, histopathology, and morphometry were determined. All combination treatments in IH resulted in the most beneficial retinal outcomes consistent with suppression of angiogenesis growth factors during reoxygenation/reperfusion and no significant adverse effects on somatic growth. nGSH + PBS also reversed IH-induced retinopathy, but had negative effects on growth. Simultaneously targeting oxidants, inflammation, and poor growth mitigates the damaging effects of neonatal IH on the developing retina. Therapeutic synergy with combination delivery methods enhance individual attributes and simultaneously target multiple pathways involved in complex diseases such as OIR.
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Affiliation(s)
- Kay D. Beharry
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- SUNY Eye Institute, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- Correspondence: ; Tel.: +01-718-270-1475
| | - Charles L. Cai
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Faisal Siddiqui
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Christina D’Agrosa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Anano Zangaladze
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Ghassan Mustafa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Areej Qadri
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Thomas J. Duggan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Jacob V. Aranda
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- SUNY Eye Institute, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
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17
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Bolisetty S, Osborn D, Schindler T, Sinn J, Deshpande G, Wong CS, Jacobs SE, Phad N, Pharande P, Tobiansky R, Luig M, Trivedi A, Mcintosh J, Josza E, Opie G, Downe L, Andersen C, Bhatia V, Kumar P, Malinen K, Birch P, Simmer K, McLeod G, Quader S, Rajadurai VS, Hewson MP, Nair A, Williams M, Xiao J, Ravindranathan H, Broadbent R, Lui K. Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017. BMC Pediatr 2020; 20:59. [PMID: 32035481 PMCID: PMC7007668 DOI: 10.1186/s12887-020-1958-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. METHODS A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. RESULTS Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. CONCLUSIONS The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.
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Affiliation(s)
- Srinivas Bolisetty
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
- Conjoint Lecturer, University of New South Wales, Sydney, Australia
| | - David Osborn
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Tim Schindler
- Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - John Sinn
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | | | | | - Susan E. Jacobs
- Deputy Clinical Director and Neonatal Paediatrician, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Nilkant Phad
- John Hunter Children’s Hospital, Newcastle, Australia
| | | | | | | | - Amit Trivedi
- The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Eszter Josza
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
| | - Gillian Opie
- Head and Neonatal Paediatrician, Mercy Hospital for Women, Heidelberg, Victoria Australia
| | | | - Chad Andersen
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | - Vineesh Bhatia
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | | | - Katri Malinen
- PGCert Clinical Education, PGDip Child Health (associate), Advanced Pharmacist, Townsville Hospital, Townsville, Australia
| | - Pita Birch
- Gold Coast University Hospital, Southport, Australia
| | - Karen Simmer
- King Edward Memorial Hospital for Women, Subiaco, Australia
| | - Gemma McLeod
- King Edward Memorial and Princess Margaret Hospitals, Subiaco, Australia
| | - Suzanne Quader
- The Sydney Children’s Hospital Network, Sydney, Australia
| | | | | | - Arun Nair
- Waikato Hospital, Hamilton, New Zealand
| | | | | | | | | | - Kei Lui
- University of New South Wales, Sydney, Australia
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18
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Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study. Br J Nutr 2020; 123:1024-1031. [PMID: 31964427 DOI: 10.1017/s0007114520000240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a multifactor pathology. Animal studies and cohort studies suggest that poor nutrient intake after birth increases the risk of BPD. The objective of the present study was to determine the existence of association between BPD in very low birth weight (VLBW) and energy intake during the first week of life. We recorded in a retrospective cohort study the intake of enteral and parenteral macronutrients during this period by examining the nutritional and clinical history of 450 VLBW newborns admitted to the neonatal intensive care unit. After applying the relevant exclusion criteria, data for 389 VLBW infants were analysed, of whom 159 developed some degree of BPD. Among the newborns with BPD, energy and lipid intake was significantly lower and fluid intake was significantly higher. The energy intake for the 25th percentile in the group without BPD was 1778·2 kJ/kg during the first week of life. An energy intake <1778·2 kJ/kg in this period was associated with a 2-fold increase in the adjusted risk of BPD (OR 2·63, 95 % CI 1·30, 5·34). The early nutrition and the increase of energy intake in the first week of life are associated in our sample with a lower risk of BPD developing.
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19
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Calkins KL, Puder M, Gura K. The evolving use of intravenous lipid emulsions in the neonatal intensive care unit. Semin Perinatol 2019; 43:151155. [PMID: 31331633 DOI: 10.1053/j.semperi.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Parenteral nutrition and intravenous lipid emulsions are essential for promoting optimal nutrition in the neonatal intensive care unit. However, long-term use of a pure soybean lipid emulsion is associated with a liver disease known as intestinal failure associated liver disease. Over the past several years, the science of lipid emulsions has evolved with a focus on nutritional optimization and disease prevention. This review's purpose is to provide a general overview of the three main components of lipid emulsions, phytosterols, the antioxidant Vitamin E, and polyunsaturated fatty acids, and their contribution to health.
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Affiliation(s)
- Kara L Calkins
- Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA, United States.
| | - Mark Puder
- Harvard Medical School, Boston, MA, United States; Department of Surgery and the Vascular Biology Program, Boston Children's Hospital, Boston, MA, United States
| | - Kathleen Gura
- Harvard Medical School, Boston, MA, United States; Department of Pharmacy, Boston Children's Hospital, Boston, MA, United States
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20
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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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Abstract
BACKGROUND Lipid emulsions (LE) form a vital component of infant nutrition for critically ill, late preterm or term infants, particularly for those with gastrointestinal failure. Conventionally used soybean oil-based LE (S-LE) have high polyunsaturated fatty acid (PUFA) content and phytosterols, which may contribute to adverse effects including parenteral nutrition-associated liver disease (PNALD). OBJECTIVES To compare the safety and efficacy of all LE for parenteral nutrition (PN) in term and late preterm infants (between 34 weeks' gestation and 36 weeks' and six days' gestation) with or without surgical conditions or PNALD within first six months of life, using all possible direct comparisons. 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 June 2018), CINAHL (1982 to 18 June 2018), MIDRIS (1971 to 31 May 2018), conference proceedings, trial registries (ClinicalTrials.gov and the WHO's Trials Registry), and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised controlled studies in term and late preterm infants, with or without surgical conditions or PNALD. 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 the conventional statistical significance of results. MAIN RESULTS The review included nine randomised studies (n = 273). LE were classified in three broad groups: 1. all fish oil-containing LE including pure fish oil (F-LE) and multisource LE (e.g. medium-chain triglycerides (MCT)-olive-fish-soybean oil-LE (MOFS-LE), MCT-fish-soy oil-LE (MFS-LE) and olive-fish-soy-LE (OFS-LE)); 2. conventional pure S-LE; 3. alternative-LE (e.g. MCT-soy-LE (MS-LE), olive-soy-LE (OS-LE) and borage oil-based LE).We considered four broad comparisons: 1. all fish oil LE versus non-fish oil LE (6 studies; n = 182); 2. fish oil LE versus another fish oil LE (0 studies); 3. alternative-LE versus S-LE (3 studies; n = 91); 4. alternative-LE versus another alternative-LE (0 studies) in term and late preterm infants (0 studies), term and late preterm infants with surgical conditions (7 studies; n = 233) and term and late preterm infants with PNALD/cholestasis (2 studies; n = 40).PNALD/cholestasis was defined as conjugated bilirubin (Cbil) 2 mg/dL or greater and resolution of PNALD/cholestasis as Cbil less than 2 mg/dL. We put no restriction on timing of PNALD detection. There was heterogeneity in definitions and time points for detecting PNALD in the included studies.We found one study each in surgical infants and in infants with cholestasis, showing no evidence of difference in incidence or resolution of PNALD/cholestasis (Cbil cut-off: 2 mg/dL) with use of fish oil-containing LE compared to S-LE.We considered an outcome allowing for any definition of PNALD (different Cbil cut-off levels). In infants with surgical conditions and no pre-existing PNALD, meta-analysis showed no difference in the incidence of PNALD/cholestasis (any definition) with use of fish oil-containing LE compared to S-LE (typical risk ratio (RR) 1.20, 95% confidence interval (CI) 0.38 to 3.76; typical risk difference (RD) 0.03, 95% CI -0.14 to 0.20; 2 studies; n = 68; low-quality evidence). In infants with PNALD/cholestasis (any definition), use of fish oil-LEs was associated with significantly less cholestasis compared to the S-LE group (typical risk ratio (RR) 0.54, 95% confidence interval (CI) 0.32 to 0.91; typical risk difference (RD) -0.39, 95% CI -0.65 to -0.12; number needed to treat for additional beneficial outcome (NNTB) 3, 95% CI 2 to 9; 2 studies; n = 40; very low-quality evidence). This outcome had very low number of participants from two small studies with differences in study methodology and early termination in one study, which increased uncertainty about the effect estimates.One study in infants with cholestasis reported significantly better weight gain with a pure fish oil LE compared to a 10% S-LE (45 g/week, 95% CI 15.0 to 75.0; n = 16; very low-quality evidence). There were no significant differences in growth parameters in studies with surgical populations.For the secondary outcomes, in infants with cholestasis, one study (n = 24) reported significantly lower conjugated bilirubin levels but higher gamma glutamyl transferase levels with MOFS-LE (SMOFlipid) versus S-LE (Intralipid) and another study (n = 16), which was terminated early, reported significantly higher rates of rise in alanine aminotransferase (ALT) and conjugated bilirubin levels in the S-LE group compared to pure F-LE (Omegaven).In surgical infants, two studies each reported on hypertriglyceridaemia and Cbil levels with one study in each outcome showing significant benefit with use of a F-LE and the other study showing no difference between the groups. Meta-analysis was not performed for either of these outcomes as there were only two studies showing conflicting results with high heterogeneity between the studies.There was no evidence of differences in death, sepsis, alkaline phosphatase and ALT levels in infants with surgical conditions or cholestasis (very low-quality evidence).One study reported neurodevelopmental outcomes at six and 24 months in infants with surgical conditions (n = 11) with no evidence of difference with use of pure F-LE versus S-LE. Another study in infants with cholestasis (n = 16) reported no difference in head growth velocity between pure F-LE versus S-LE.GRADE quality of evidence ranged from low to very low as the included studies were small single-centre studies. Three of the six studies that contributed data to the review were terminated early for various reasons. AUTHORS' CONCLUSIONS Based on the current review, there is insufficient data from randomised studies to determine with any certainty, the potential benefit of any LE including fish oil-containing LEs over another LE, for prevention or resolution of PNALD/cholestasis or any other outcomes in term and late preterm infants with underlying surgical conditions or cholestasis. There were no studies in infants without surgical conditions or cholestasis.Further research is required to establish role of fish oil or lipids from other sources in LEs to improve PNALD/cholestasis, and other clinical outcomes in parenterally fed term and late preterm infants.
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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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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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Hsiao CC, Lin HC, Chang YJ, Yang SP, Tsao LY, Lee CH, Chen HN, Chen JY, Tsai YG. Intravenous fish oil containing lipid emulsion attenuates inflammatory cytokines and the development of bronchopulmonary dysplasia in very premature infants: A double-blind, randomized controlled trial. Clin Nutr 2019; 38:1045-1052. [DOI: 10.1016/j.clnu.2018.06.929] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022]
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Türkyılmaz C, Bilgen H, Kültürsay N. Turkish Neonatal Society guideline on parenteral nutrition in preterm infants. TURK PEDIATRI ARSIVI 2018; 53:S119-S127. [PMID: 31236025 PMCID: PMC6568298 DOI: 10.5152/turkpediatriars.2018.01812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Postnatal growth failure due to inappropriate and insufficient nutrition is a risk for preterm infants, especially for very-low-birth-weight or extremely-low-birth-weight infants. This extrauterine growth failure causes negative effects on long-term neurodevelopment. Early initiation of intensive parenteral nutrition with appropriate protein and energy supply is a nutritional emergency when enteral feeding cannot be achieved. This approach prevents protein catabolism and helps achievement of positive protein balance and postnatal growth. Protein, lipid, and glucose initiation with appropriate doses that reach timely goals constitute the major elements of parenteral nutrition. The transition to enteral nutrition with the mother's milk at the earliest convenience must be targeted in parenteral nutrition.
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Affiliation(s)
- Canan Türkyılmaz
- Division of Neonatology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Hülya Bilgen
- Division of Neonatology, Department of Pediatrics, Marmara University, Faculty of Medicine, İstanbul, Turkey
| | - Nilgün Kültürsay
- Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
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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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Hypertriglyceridaemia in extremely preterm infants receiving parenteral lipid emulsions. BMC Pediatr 2018; 18:348. [PMID: 30404604 PMCID: PMC6220513 DOI: 10.1186/s12887-018-1325-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lipid emulsions (LE) are routinely administered as part of parenteral nutrition in neonates. There is a wide variation in clinical practice of plasma triglyceride monitoring during LE therapy. Our aim was to evaluate the incidence of hypertriglyceridaemia (Plasma triglyceride > 2.8 mmol/L) and its association with mortality and major morbidities in extremely preterm infants on parenteral nutrition. Methods A retrospective review of 195 infants < 29 weeks gestation. Lipid emulsion was commenced at 1 g/kg/day soon after birth and increased by 1 g/kg daily up to 3 g/kg/day and continued until the infant was on at least 120 ml/kg/day of enteral feeds. Plasma triglyceride concentrations were measured at each increment and the lipid emulsion dosage was adjusted to keep plasma triglyceride concentrations ≤2.8 mmol/L. Results Hypertriglyceridemia was noted in 38 neonates (32.5% in 23–25 weeks and 16.1% in 26–28 weeks). Severe hypertriglyceridemia (> 4.5 mmol/L) was noted in 11 infants (10.0% in 23–25 weeks and 4.5% in 26–28 weeks). Hypertriglyceridemia was associated with an increase in mortality (unadjusted OR 3.5; 95% CI 1.13–10.76; 0.033) and severe retinopathy of prematurity (unadjusted OR 4.06; 95% CI 1.73–9.59; 0.002) on univariate analysis. However, this association became non-significant in multivariate analysis with adjustment for gestation and birthweight. Conclusions Hypertriglyceridemia is common in extremely preterm infants receiving parenteral lipid emulsions. Regular monitoring and prompt adjustment of lipid intake in the presence of hypertriglyceridemia, minimising the length of exposure to hypertriglyceridemia, may mitigate potential consequences.
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Kapoor V, Malviya MN, Soll R. Lipid emulsions for parenterally-fed term and late preterm infants. Hippokratia 2018. [DOI: 10.1002/14651858.cd013171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vishal Kapoor
- Queensland Children's Hospital; Department of Paediatrics; 501 Stanley Street Brisbane Queensland Australia 4101
| | - Manoj N Malviya
- Khoula Hospital; Neonatal Intensive Care Unit; Muscat Muscat Oman
| | - Roger Soll
- Larner College of Medicine at the University of Vermont; Division of Neonatal-Perinatal Medicine, Department of Pediatrics; 111 Colchester Avenue Burlington Vermont USA 05401
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28
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Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to compare the effectiveness and safety of lipid formulations from different sources, including soybean oil‐based, multicomponent, olive oil‐based, and fish oil–based, in parenterally fed preterm infants. The secondary objective is to determine the effectiveness and safety of alternative lipid emulsions compared with soybean oil‐based lipid emulsions in relation to gestational age (less than 30 weeks' gestation; 30 weeks' gestation or more), birth weight (1000 grams or less; more than 1000 grams), clinical condition (surgical patients, patients with established cholestasis).
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Affiliation(s)
- Vishal Kapoor
- Queensland Children's HospitalDepartment of Paediatrics501 Stanley StreetBrisbaneAustralia4101
| | | | - Roger Soll
- Larner College of Medicine at the University of VermontDivision of Neonatal‐Perinatal Medicine, Department of Pediatrics111 Colchester AvenueBurlingtonUSA05401
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29
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Lenhartova N, Matasova K, Lasabova Z, Javorka K, Calkovska A. Impact of early aggressive nutrition on retinal development in premature infants. Physiol Res 2018; 66:S215-S226. [PMID: 28937236 DOI: 10.33549/physiolres.933677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The normal retinal development is interrupted by preterm birth and a retinopathy of prematurity (ROP) may develop as its consequence. ROP is characterized by aberrant vessel formation in the retina as a response to multiple risk factors influencing the process of retinal angiogenesis. Insulin-like growth factor I (IGF-1) and vascular endothelial growth factor (VEGF) play an important role in the process of normal retinal vascularization. Insufficient nutrition during the first 4 postnatal weeks results in low serum levels of IGF-1, which is essential for correct retinal vessels formation, ensuring survival of the newly formed endothelial cells. Low IGF-1 level results in stop of angiogenesis in the retina, leaving it avascular and prompting the onset of ROP. Keeping the newborns in a positive energetic balance by providing enough nutrients and energy has a beneficial impact on their growth, neurodevelopment and decreased incidence of ROP. The best way to achieve this is the early parenteral nutrition with the high content of nutrients combined with early enteral feeding by the own mother´s breast milk. Multiple studies confirmed the safety and efficacy of early aggressive nutrition but information about its long-term effects on the metabolism, growth and development is still needed.
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Affiliation(s)
- N Lenhartova
- Clinic of Neonatology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital, Martin, Slovakia.
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Darmaun D, Lapillonne A, Simeoni U, Picaud JC, Rozé JC, Saliba E, Bocquet A, Chouraqui JP, Dupont C, Feillet F, Frelut ML, Girardet JP, Turck D, Briend A. Parenteral nutrition for preterm infants: Issues and strategy. Arch Pediatr 2018; 25:286-294. [PMID: 29656825 DOI: 10.1016/j.arcped.2018.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/26/2018] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.
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Affiliation(s)
- D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France.
| | | | - U Simeoni
- Université de Lausanne, CHUV, 1011 Lausanne, Suisse
| | - J-C Picaud
- Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - J-C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - E Saliba
- Université François-Rabelais, 37000 Tours, France
| | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | | | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Université Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J-P Girardet
- Université Pierre et Marie Curie-Paris 6, 75005 Paris, France
| | - D Turck
- Université Lille 2, LIRIC-Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
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Roelants JA, Vlaardingerbroek H, van den Akker CHP, de Jonge RCJ, van Goudoever JB, Vermeulen MJ. Two-Year Follow-up of a Randomized Controlled Nutrition Intervention Trial in Very Low-Birth-Weight Infants. JPEN J Parenter Enteral Nutr 2017; 42:122-131. [PMID: 27875287 DOI: 10.1177/0148607116678196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Very low-birth-weight (VLBW) infants are at risk for neurodevelopment impairment. This study assessed the effect of early aggressive parenteral nutrition (PN) on long-term outcome in VLBW infants. MATERIALS AND METHODS Directly after birth, VLBW infants (birth weight <1500 g, n = 142) were randomized to 5 different PN regimes. Controls (n = 46) received glucose and standard-dose amino acids (AAs; 2.4 g/[kg·d]) from birth onward and pure soybean oil fat emulsion (SOY) on the second day of life. Two intervention groups received glucose, standard-dose AAs, and lipids from birth onward: SOY (n = 24) or mixed fat emulsion (MIX, n = 25). The 2 other intervention groups received glucose, high-dose AAs (3.6 g/[kg·d]), and lipids from birth onward: SOY (n = 24) or MIX (n = 23). The primary outcome of this follow-up study was the composite outcome of "death or major disability" at 2 years corrected age. Secondary outcomes were death, major disabilities, neurodevelopmental scores, and anthropometry. RESULTS Follow-up rate was 92% (n = 134). Thirty-five (26%) infants had died or had a major disability, with no differences between intervention groups and controls. Increased odds for death were observed in the standard-dose AA-MIX group (odds ratio, 5.4; 95% confidence interval [CI], 1.1-27.0). Neurodevelopmental scores and incidence of major disabilities did not differ between groups. Growth in the high-dose AA-MIX group was enhanced compared with growth in controls at 2 years corrected age (+0.51 [0.01-1.02] weight SDS). CONCLUSION This randomized controlled hypothesis-generating study demonstrated no beneficial effect of early high-dose AA administration and mixed fat emulsions on survival and neurodevelopmental outcome in VLBW infants, although growth was enhanced.
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Affiliation(s)
- Jorine A Roelants
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Gynecology and Obstetrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hester Vlaardingerbroek
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatrics, Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands
| | - Chris H P van den Akker
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pediatrics, Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital-Academic Medical Center, Amsterdam, the Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Riskin A. Meeting the nutritional needs of premature babies: their future is in our hands. Br J Hosp Med (Lond) 2017; 78:690-694. [PMID: 29240511 DOI: 10.12968/hmed.2017.78.12.690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The goals of early nutrition in preterm infants are to provide all the necessary vital nutrients, achieve extra-uterine growth rates similar to fetuses of the same gestational age, and support functional neurodevelopmental outcomes that are comparable to those of infants born at term. It is vital to provide nutrition that will maximally support brain growth and development, but over-feeding with accelerated growth, fat accumulation and long-term metabolic consequences should also be avoided. Because the morbidity associated with prematurity increases nutritional and energetic demands, the basic approach is of providing early intensive nutrition. Protein is the main driving force for growth and brain development. Since deficits in protein occur from the first day of extra-uterine life, sufficient quantities of parenteral amino acids should be provided from the first hours of life. With protein and carbohydrates, enough energy should also be provided, via concomitant early administration of intravenous lipid emulsions. Early initiation of enteral feeding with advancement to full enteral nutrition is associated with better maturation of the gut and better neuro-developmental outcomes. Human milk is the best food for preterm babies, although enrichment may be needed.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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33
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[Parenteral nutrition in premature babies with a birth weight <1500g: a systematic single-center analysis and comparison with current guidelines]. Wien Med Wochenschr 2017; 169:71-81. [PMID: 29030727 DOI: 10.1007/s10354-017-0602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/25/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Parenteral and enteral nutrition are essential for both growth and development of preterm infants. Based on the results of many studies, the rate of nutritional growth and the amount of substrate delivered parenterally are under debate. OBJECTIVE The main aim of this study was to assess parenteral nutrition in very and extremely immature preterm infants, i.e. very low birth weight (VLBW, birth weight <1500g) and extremely low birth weight (ELBW, birth weight <1000g) neonates, and to compare the amount of parenterally delivered substrate in our neonatal intensive care unit (NICU) to current German guidelines. METHODS Retrospective audit at our tertiary NICU at the University Children's Hospital of Saarland, Homburg, Germany between 1 January 2009 and 31 December 2010. RESULTS In total, 100 premature neonates were included. The mean gestational age was 29.6 weeks (range 24.4-34.1 weeks) and the mean birth weight was 1119 g ± 260 g (range 570 g-1490 g). Comparing the amount of fluids, glucose, amino acids, lipids and kcals with the current guidelines of the German Society for Nutritional Medicine in preterm infants, only glucose was adequately given; however, a substantial number of weight-dependent (more often in ELBW neonates) episodes of hyperglycemia requiring insulin treatment were also seen. During the first 3 weeks of life a substantial drop in body weight, length and head circumference occurred in our study cohort. In contrast, at 2 years corrected age, catch-up growth was seen in our cohort with anthropometric data now comparable to healthy term infants. Using the Bayley II test for developmental outcome assessment, at 2 years corrected age 78.6% (33/42) of infants demonstrated normal development. CONCLUSIONS This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.
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Calder PC, Adolph M, Deutz NE, Grau T, Innes JK, Klek S, Lev S, Mayer K, Michael-Titus AT, Pradelli L, Puder M, Vlaardingerbroek H, Singer P. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr 2017; 37:1-18. [PMID: 28935438 DOI: 10.1016/j.clnu.2017.08.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
This article summarizes the presentations given at an ESPEN Workshop on "Lipids in the ICU" held in Tel Aviv, Israel in November 2014 and subsequent discussions and updates. Lipids are an important component of enteral and parenteral nutrition support and provide essential fatty acids, a concentrated source of calories and building blocks for cell membranes. Whilst linoleic acid-rich vegetable oil-based enteral and parenteral nutrition is still widely used, newer lipid components such as medium-chain triglycerides and olive oil are safe and well tolerated. Fish oil (FO)-enriched enteral and parenteral nutrition appears to be well tolerated and confers additional clinical benefits, particularly in surgical patients, due to its anti-inflammatory and immune-modulating effects. Whilst the evidence base is not conclusive, there appears to be a potential for FO-enriched nutrition, particularly administered peri-operatively, to reduce the rate of complications and intensive care unit (ICU) and hospital stay in surgical ICU patients. The evidence for FO-enriched nutrition in non-surgical ICU patients is less clear regarding its clinical benefits and additional, well-designed large-scale clinical trials need to be conducted in this area. The ESPEN Expert Group supports the use of olive oil and FO in nutrition support in surgical and non-surgical ICU patients but considers that further research is required to provide a more robust evidence base.
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Affiliation(s)
- Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, United Kingdom.
| | - Michael Adolph
- Department of Anesthesiology and Intensive Care Medicine, Nutrition Support Team, University Clinic Tübingen, 72074 Tübingen, Germany
| | - Nicolaas E Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Teodoro Grau
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Jacqueline K Innes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stanislaw Klek
- General and Oncology Surgery Unit, Intestinal Failure Center, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Shaul Lev
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Konstantin Mayer
- Department of Internal Medicine, Med. Clinik II, University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Adina T Michael-Titus
- Centre for Neuroscience and Trauma, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Lorenzo Pradelli
- AdRes Health Economics and Outcomes Research, 10121 Turin, Italy
| | - Mark Puder
- Vascular Biology Program and the Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Hester Vlaardingerbroek
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Hasharon Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Roelants JA, Joosten KFM, van der Geest BMA, Hulst JM, Reiss IKM, Vermeulen MJ. First week weight dip and reaching growth targets in early life in preterm infants. Clin Nutr 2017; 37:1526-1533. [PMID: 28912010 DOI: 10.1016/j.clnu.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Aggressive parenteral nutritional practices were implemented in clinical practice over a decade ago to prevent early growth retardation in preterm infants. We aimed to study adherence to current nutritional recommendations in a population of very preterm infants, and to evaluate growth in early life. METHODS Preterm infants (gestational age <30 weeks and birth weight <1500 g) were included in a prospective observational cohort study. Data on parenteral and enteral intake were collected on days 1-7, 14, 21 and 28 (d28) of life. Growth data were collected at birth, at moment of maximal weight loss (dip), and either at discharge from the neonatal intensive care unit or at d28, whichever came first. Nutritional intakes were compared to recommendations of current guidelines. The target growth rate was 15-20 g/kg/d. RESULTS Fifty-nine infants (63% male) were included. Median gestational age was 27 3/7 (interquartile range 25 6/7;28 4/7), and birth weight was 920 g (720;1200). Median macronutrient intakes were within or above the targets on all study days, but energy targets were not met before day 5. Median growth rates were 9.5 and 18.1 g/kg/d, when calculated from respectively birth and dip to discharge/d28. Eight (14%) versus 46 (78%) infants met the growth targets, when evaluated from respectively birth and dip to discharge/d28. CONCLUSIONS In this cohort, only energy intake up to day 5 was lower than recommended. Growth targets were achieved in the majority of the infants, but only when evaluated from dip onward, not from birth.
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Affiliation(s)
- Jorine A Roelants
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Brigitte M A van der Geest
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Department of Dietetics, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Jessie M Hulst
- Department of Pediatrics, Division of Pediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
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Edward RR, Innes JK, Marino LV, Calder PC. Influence of different intravenous lipid emulsions on growth, development and laboratory and clinical outcomes in hospitalised paediatric patients: A systematic review. Clin Nutr 2017; 37:765-783. [PMID: 28712532 DOI: 10.1016/j.clnu.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Fats in the form of lipid emulsions (LEs) are an integral part of intravenous nutrition. The fatty acid composition of different LEs varies. The exact composition of a LE may influence cell and tissue function and clinical outcome. Currently, it is not clear which LE might be best for paediatric patients. We conducted a systematic review of the effects of different intravenous LEs in hospitalised paediatric patients. METHODS Randomised controlled trials published in a peer reviewed journal, written in the English language, and comparing two or more different intravenous LEs in hospitalised paediatric patients were included. Data on outcomes of relevance (growth, development, laboratory and clinical outcomes) were extracted, collated and interpreted. RESULTS Thirty-one articles involving 1522 infants or children were included. Most outcomes were not affected by the nature of the LE used. LEs containing fish oil, a source of omega-3 fatty acids, improved outcome of retinopathy of prematurity, decreased liver cholestasis and increased blood omega-3 fatty acid levels. LEs containing olive oil increased blood oleic acid level and had a cholesterol lowering effect. CONCLUSION Blood fatty acids are influenced by the nature of the intravenous LE used in hospitalised paediatric patients. Most studies suggest limited differences in relevant laboratory or clinical outcomes or in growth in paediatric patients receiving different LEs, although several studies do find benefits from including fish oil or olive oil. There is a need for larger trials to fully evaluate the effects of the available LE types in hospitalised paediatric patients.
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Affiliation(s)
- Roy-Rosshan Edward
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Jacqueline K Innes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Luise V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton SO16 6YD, United Kingdom.
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Abstract
With advancements in the care of preterm infants, the goals in nutritional care have expanded from survival and mimicking fetal growth to optimizing neurodevelopmental outcomes. Inadequate nutritional support may be a risk factor for major complications of prematurity; conversely, higher disease burden is a risk for growth restriction. Early complete parenteral nutrition support, including intravenous lipid emulsion, should be adopted, and the next challenge that should be addressed is parenteral nutrition customized to fit the specific needs and metabolism of the extremely preterm infant. Standardized feeding protocols should be adopted.
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Affiliation(s)
- Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Ting Ting Fu
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Brenda Poindexter
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
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Unal S, Demirel N, Erol S, Isik DU, Kulali F, Iyigun F, Bas AY. Effects of two different lipid emulsions on morbidities and oxidant stress statuses in preterm infants: an observational study. J Matern Fetal Neonatal Med 2017; 31:850-856. [DOI: 10.1080/14767058.2017.1300644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sezin Unal
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Nihal Demirel
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Sara Erol
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Dilek Ulubas Isik
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Ferit Kulali
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Fatma Iyigun
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
| | - Ahmet Yagmur Bas
- Department of Neonatology, Etlik Zubeyde Hanım Women’s Teaching and Research Hospital, Ankara, Turkey
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Abstract
Preterm infants, especially very low birth weight (VLBW; <1500 g) and extremely low birth weight (ELBW; <1000 g) infants, are susceptible to growth failure in postnatal life if nutritional demands are not met. Poor postnatal growth in preterm infants is associated with adverse neurodevelopmental outcomes during childhood. Early parental nutrition is of paramount importance to provide appropriate protein and energy in VLBW infants when enteral nutrition is not feasible or is suboptimal. An "early and aggressive" approach of parenteral nutrition in preterm infants has been shown to prevent protein catabolism, induce positive nitrogen balance and improve postnatal growth.
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Affiliation(s)
- Pinkal Patel
- Division of Neonatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jatinder Bhatia
- Division of Neonatology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Guthrie G, Premkumar M, Burrin DG. Emerging Clinical Benefits of New-Generation Fat Emulsions in Preterm Neonates. Nutr Clin Pract 2017; 32:326-336. [PMID: 28129045 DOI: 10.1177/0884533616687500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Soybean oil-based intravenous fat emulsions (IVFEs) have been the predominant parenteral nutrition IVFE used in the United States for neonates over the past 45 years. Even though this emulsion has proven useful in supplying infants with energy for growth and essential fatty acids, there have been concerns over its composition in the development of several morbidities, ranging from sepsis to liver disease, bronchopulmonary dysplasia, and impaired neurodevelopment and growth. The exact mechanisms that drive these morbidities in preterm infants are multifactorial, but potential contributors include high ω-6 (n-6) fatty acid composition, low docosahexaenoic acid and antioxidant supplementation, and the presence of potentially harmful nonnutritive components (eg, phytosterols). To address these issues, new-generation IVFEs with various types and amounts of fat have been developed containing greater amounts of the medium-chain fatty acids, long-chain polyunsaturated fatty acid, docosahexaenoic acid, lower concentrations of ω-6 polyunsaturated fatty acids, supplemental vitamin E, and low or negligible amounts of phytosterols. This review examines the clinical outcomes associated with different morbidities of parenteral nutrition in neonates who have received either soybean oil-based or new-generation IVFEs and addresses whether the proposed benefits of new-generation IVFEs have improved outcomes in the neonatal population.
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Affiliation(s)
- Gregory Guthrie
- 1 USDA/ARS Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Muralidhar Premkumar
- 2 Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Douglas G Burrin
- 1 USDA/ARS Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Espiritu MM, Lin H, Foley E, Tsang V, Rhee E, Perlman J, Cunningham-Rundles S. Omega-3 fatty acids modulate neonatal cytokine response to endotoxin. J Perinat Med 2016; 44:711-21. [PMID: 26812855 DOI: 10.1515/jpm-2015-0248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
Neonatal immune response is characterized by an uncompensated pro-inflammatory response that can lead to inflammation-related morbidity and increased susceptibility to infection. We investigated the effects of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA) pre-treatment on cytokine secretion to low-concentration endotoxin (lipopolysaccharide, LPS) in THP-1 monocytes and neonatal cord blood (CB) from healthy full-term infants. Pre-treatment of THP-1 cells, with either n-3 PUFA at 25 or 100 μM significantly reduced IL-6, IL-10, and IL-12 secretion while DHA, but not EPA, reduced TNF-α response to LPS. DHA inhibition was stronger compared to EPA and effective at the low concentration. The same concentrations of n-3 PUFAs inhibited IL-12 but not IL-10 cytokine response in whole CB from 9 infants pre-treated for 24 h. To assess clinical relevance for acute response to LPS, the effects of low-concentration DHA at 25 μM or 12.5 μM were assessed before and after LPS exposure of isolated CB mononuclear cells from 20 infants for 1 h. When added before or after LPS, physiologic DHA treatment produced significant concentration-dependent inhibition of TNF-α, IL-6, IL-1β, and IL-8 secretion. The results demonstrate prophylactic and therapeutic modulation of neonatal cytokine response to LPS and provide proof-of-concept that low-concentration administration of n-3 PUFA could attenuate or resolve neonatal inflammatory response.
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Ng DVY, Brennan-Donnan J, Unger S, Bando N, Gibbins S, Nash A, Kiss A, O'Connor DL. How Close Are We to Achieving Energy and Nutrient Goals for Very Low Birth Weight Infants in the First Week? JPEN J Parenter Enteral Nutr 2016; 41:500-506. [PMID: 26160253 DOI: 10.1177/0148607115594674] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emerging evidence suggests intakes of protein and energy as early as the first week of life in preterm very low birth weight (VLBW) infants are associated with improved neurodevelopment. In response, many neonatal intensive care units (NICUs) have launched new, more aggressive early feeding guidelines. The aim of this study was to evaluate enteral and parenteral energy and macronutrient intakes during the first postnatal week in VLBW infants admitted to NICUs that have introduced more aggressive early feeding guidelines. MATERIALS AND METHODS Estimated energy and macronutrient intakes were prospectively collected from VLBW infants fed exclusively mother's own milk and/or parenteral nutrition and compared with expert recommendations. Days to reach full enteral feeds (150 mL/kg/d) and discharge anthropometrics were examined. RESULTS By days 6 and 7, median protein and lipid intakes, respectively, reached recommended values (3.5 and 3.0 g/kg/d). However, by day 8, many infants remained below recommended intakes for protein (34%), lipid (34%), carbohydrate (68%), and energy (71%). Late-onset sepsis was associated with a decreased likelihood of reaching full enteral feeds on any given day (hazard ratio, 0.2; 95% confidence interval, 0.1-0.5; P ≤ .0009). There was no significant relationship between week 1 nutrient intakes and anthropometrics at discharge. CONCLUSION Despite the introduction of more aggressive early feeding guidelines and improved energy and nutrient intakes compared with literature values, many VLBW infants remain below recommended nutrition goals in the first week.
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Affiliation(s)
- Dawn V Y Ng
- 1 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joan Brennan-Donnan
- 3 Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Unger
- 4 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,5 Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,6 Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nicole Bando
- 2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharyn Gibbins
- 7 Department of Professional Practice, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Andrea Nash
- 8 Sunnybrook Health Sciences Center Neonatal Intensive Care Unit, Toronto, Ontario, Canada
| | - Alex Kiss
- 9 Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,10 Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- 1 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Fish oil- and soy oil-based lipid emulsions in neonatal parenteral nutrition: a systematic review and meta-analysis. Eur J Clin Nutr 2016; 70:1106-1115. [PMID: 27142348 DOI: 10.1038/ejcn.2016.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 03/12/2016] [Accepted: 03/23/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVES The precise role of fish oil-based lipid emulsions (FBL=any lipid emulsion containing any amount of fish oil) and soy oil-based lipid emulsions (SBL=any lipid emulsion not containing fish oil or containing at least 50% soy oil) in neonatal parenteral nutrition (PN) needs to be explored. SUBJECTS/METHODS The PubMed, MedLine and Google Scholar databases were searched for randomised control trials in which PN with FBL and SBL was the only difference between intervention and control groups. Methodological quality was assessed based on the Cochrane handbook for systemic reviews and Jadad's score. Revman 5.2 software was used for meta-analysis. RESULTS Of 420 trials, 25 met the inclusion criteria. The aggregate results showed that both FBLs and SBLs are beneficial. FBLs were associated with significantly lower incidences of cholestasis (relative risk (RR)=0.50; 95% confidence interval (CI)=0.27-0.92, P=0.03) compared with SBLs. FBLs also had a tendency to improve the rates of weight gain, increase in head circumference and the time to regain birth weight (mean difference (MD)=0.24; 95% CI=-0.63-0.15). SBLs were associated with reduced duration of respiratory support (MD=2.22, 95% CI=0.35-4.09, P=0.02) and mortality rate in the first 28 days (RR=1.24, 95% CI=-0.72-2.13). CONCLUSIONS Both FBLs and SBLs are beneficial for neonatal PN. FBLs reduce cholestasis, and SBLs reduce the duration of respiratory support.
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Abstract
The goal of preterm nutrition in achieving growth and body composition approximating that of the fetus of the same postmenstrual age is difficult to achieve. Current nutrition recommendations depend largely on expert opinion, due to lack of evidence, and are primarily birth weight based, with no consideration given to gestational age and/or need for catch-up growth. Assessment of growth is based predominately on anthropometry, which gives insufficient attention to the quality of growth. The present paper provides a review of the current literature on the nutritional management and assessment of growth in preterm infants. It explores several approaches that may be required to optimise nutrient intakes in preterm infants, such as personalising nutritional support, collection of nutrient intake data in real-time, and measurement of body composition. In clinical practice, the response to inappropriate nutrient intakes is delayed as the effects of under- or overnutrition are not immediate, and there is limited nutritional feedback at the cot-side. The accurate and non-invasive measurement of infant body composition, assessed by means of air displacement plethysmography, has been shown to be useful in assessing quality of growth. The development and implementation of personalised, responsive nutritional management of preterm infants, utilising real-time nutrient intake data collection, with ongoing nutritional assessments that include measurement of body composition is required to help meet the individual needs of preterm infants.
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Kapoor V, Glover R, Malviya MN. Alternative lipid emulsions versus pure soy oil based lipid emulsions for parenterally fed preterm infants. Cochrane Database Syst Rev 2015; 2015:CD009172. [PMID: 26630252 PMCID: PMC7195185 DOI: 10.1002/14651858.cd009172.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The pure soybean oil based lipid emulsions (S-LE) conventionally used for parenteral nutrition (PN) in preterm infants have high polyunsaturated fatty acid (PUFA) content. The newer lipid emulsions (LE) from alternative lipid sources with reduced PUFA content may improve clinical outcomes in preterm infants. OBJECTIVES To determine the safety and efficacy of the newer alternative LE compared with the conventional S-LE for PN in preterm infants. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG) to search the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 7), MEDLINE (1946 to 31 July 2015), EMBASE (1947 to 31 July 2015), CINAHL (1982 to 31 July 2015), Web of Science (31 July 2015), conference proceedings, trial registries (clinicaltrials.gov, controlled-trials.com, WHO's ICTRP), and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in preterm infants (< 37 weeks), comparing newer alternative LE with S-LE. DATA COLLECTION AND ANALYSIS Data collection and analysis conformed to the methods of the CNRG. We assessed the quality of evidence for important outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, in addition to reporting the conventional statistical significance of results. MAIN RESULTS Fifteen studies (N = 979 infants) are included in this review. Alternative LE including medium chain triglycerides/long chain triglycerides (MCT/LCT) LE (3 studies; n = 108), MCT-olive-fish-soy oil-LE (MOFS-LE; 7 studies; n = 469), MCT-fish-soy oil-LE (MFS-LE; 1 study; n = 60), olive-soy oil-LE (OS-LE; 7 studies; n = 406), and borage-soy oil-LE (BS-LE; 1 study; n = 34) were compared with S-LE. The different LE were also considered together to compare 'all fish oil containing-LE' versus S-LE (7 studies; n = 499) and 'all alternative LE' versus S-LE (15 studies; n = 979). Some studies had multiple intervention arms and were included in more than one comparison. No study compared pure fish oil-LE or structured-LE to S-LE.The GRADE quality of evidence (GRADE QoE) ranged from 'low' to 'very low.' Evidence came mostly from small single centre studies, many focusing on biochemical aspects as their primary outcomes, with optimal information size not achieved for the important clinical outcomes in any comparison.In the primary outcomes of the review there was a pooled effect towards decreased bronchopulmonary dysplasia (BPD) in OS-LE vs S-LE (4 studies, n = 261) not reaching statistical significance (typical risk ratio (RR) 0.69, 95% confidence interval (CI) 0.46 to 1.04, I² = 32%; typical risk difference (RD) -0.08, 95% CI -0.17 to 0.00, I² = 76%; GRADE QoE: 'very low'). No difference in BPD was observed in any other comparison. There were no statistically significant differences in the primary outcomes of death, growth rate (g/kg/day) or days to regain birth weight in any comparison.Retinopathy of prematurity (ROP) stage 1-2 was reported to be statistically significantly lower in one single centre study (n = 80) in the MOFS-LE group compared with the S-LE group (1/40 vs 12/40, respectively; RR 0.08, 95% CI 0.01 to 0.61; RD -0.27, 95% CI -0.43 to -0.12; number needed to benefit (NNTB) 4, 95% CI 2 to 8). However there were no statistically significant differences in the secondary outcome of ROP ≥ stage 3 in any of the individual studies or in any comparison (GRADE QoE: 'low' to 'very low'). No other study reported on ROP stages 1 and 2 separately.There were no statistically significant differences in the secondary outcomes of sepsis, PN associated liver disease (PNALD)/cholestasis, ventilation duration, necrotising enterocolitis (NEC) ≥ stage 2, jaundice requiring treatment, intraventricular haemorrhage grade III-IV, periventricular leukomalacia (PVL), patent ductus arteriosus (PDA), hypertriglyceridaemia, and hyperglycaemia in any comparison.No study reported on neurodevelopmental outcomes or essential fatty acid deficiency. AUTHORS' CONCLUSIONS All lipid emulsions in this review appeared to be safe and were well tolerated in preterm infants. Compared with the pure soy oil based LE, use of MOFS-LE was associated with a decrease in the early stages (1-2) of ROP in one study. However there were no statistically significant differences in clinically important outcomes including death, growth, BPD, sepsis, ROP ≥ stage 3, and PNALD with the use of newer alternative LE versus the conventional pure soy oil based LE (GRADE QoE ranged from 'low' to 'very low'). Currently there is insufficient evidence to recommend any alternative LE over S-LE or vice versa in preterm infants.Larger randomised studies focusing on important clinical outcomes, targeting specific 'at risk' population subgroups (e.g. extreme prematurity, long term PN, etc), and exploring the effect of different proportions of lipid constituents are required to evaluate the effectiveness of newer lipid emulsions compared with the conventional pure soy based LE in preterm infants.
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Affiliation(s)
- Vishal Kapoor
- Department of Paediatrics, Redland Hospital, Weippin Street, Cleveland, Queensland, Australia, 4163
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Safety and efficacy of parenteral fish oil-containing lipid emulsions in premature neonates. J Pediatr Gastroenterol Nutr 2015; 60:708-16. [PMID: 25514619 DOI: 10.1097/mpg.0000000000000665] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the safety and efficacy of fish oil-containing (FO) lipid emulsions that are rich in ω-3 fatty acids for parenteral nutrition in preterm neonates by using data retrieved from randomized controlled trials. METHODS We performed a meta-analysis of 8 randomized controlled trials representing 483 premature neonates to compare FO with control (CO) lipid emulsions. RESULTS This meta-analysis revealed that the levels of ω-3 fatty acids in the form of docosahexaenoic acid, eicosapentaenoic acid, and arachidonic acid (% of total fatty acids) in plasma were statistically higher in FO groups (mean difference [MD] -0.7%, 95% confidence interval [CI] -1.05 to -0.36, P < 0.001; MD -1.31%, 95% CI -1.40 to -1.21, P < 0.001). The differences were found in red blood cell (RBC) membranes. The levels of arachidonic acid (% of total fatty acids) as ω-6 fatty acid in plasma and red blood cell membranes were significantly lower in FO groups (MD 1.27%, 95% CI 1.12-1.42, P < 0.001) (MD 0.92%, 95% CI 0.12-1.72, P = 0.02). The mean body weight, serum level of bilirubin, triglycerides or C-reactive protein, all-cause mortality, and rate of lipid emulsion-associated complications were, however, not different between FO and CO groups. CONCLUSIONS The level of docosahexaenoic acid is efficiently improved by FO lipid emulsions. The changes observed in eicosapentaenoic acid and arachidonic acid, and the associated safety issue, however, remain to be clarified. Any clinical benefit or detrimental effect of using FO in premature neonates cannot be demonstrated by the present study.
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Vlaardingerbroek H, Schierbeek H, Rook D, Vermeulen MJ, Dorst K, Vermes A, van Goudoever JB, van den Akker CHP. Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration. Clin Nutr 2015; 35:344-350. [PMID: 26028361 DOI: 10.1016/j.clnu.2015.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 04/04/2015] [Accepted: 04/29/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Albumin is one of the most important plasma proteins and plays a key role in many physiologic processes, such as preserving colloid osmotic pressure, scavenging radicals, and binding and transporting bilirubin, hormones, and drugs. However, albumin concentrations are often low in preterm infants during the first days of life. We hypothesized that early parenteral lipid and high-dose amino acid (AA) administration to very low birth weight (VLBW) infants from birth onwards increases hepatic albumin synthesis rates. METHODS Inborn VLBW infants were randomized to receive from birth onwards either 2.4 g amino acids/(kg(·)d) (control group), 2.4 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (AA + lipid group), or 3.6 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (high AA + lipid group). On postnatal day 2, infants received a primed continuous infusion of [U-(13)C6,(15)N]leucine. Mass spectrometry was used to determine the fractional and absolute albumin synthesis rates (FSR and ASR, respectively). RESULTS In total, 28 infants (median gestational age 27 weeks (IQR 25-28), median birth weight 810 g (IQR 679-998) were studied. The median FSR was 6.5%/d in the control group, 10.6%/d in the AA group, and 12.3%/d in the high AA + lipid group, while the median was 84 mg/(kg(·)d) in the control group, 138 mg/(kg(·)d) in the AA group, and 160 mg/(kg(·)d) in the high AA + lipid group. CONCLUSION A group of VLBW infants given parenteral nutrition containing lipids and high-dose amino acids showed a higher rate of albumin synthesis compared to infants receiving no lipids and standard amounts of amino acids during the first two days of life.
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Affiliation(s)
- Hester Vlaardingerbroek
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Henk Schierbeek
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Denise Rook
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Kristien Dorst
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Andras Vermes
- Hospital Pharmacy, Erasmus MC, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Department of Pediatrics, VU University Medical Center, c/o Room ZH 9D11, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Chris H P van den Akker
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Berding K, Makarem P, Hance B, Axel AMD, Nolan V, Buddington KK, Buddington RK. Responses of Preterm Pigs to an Oral Fluid Supplement During Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2015; 40:934-43. [PMID: 25754441 DOI: 10.1177/0148607115574746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nutrients and electrolytes in amniotic fluid swallowed by fetuses are important for growth and development. Yet, preterm infants requiring parenteral nutrition (PN) receive minimal or no oral inputs. With the limited availability of amniotic fluid, we evaluated the responses of preterm pigs receiving PN to an oral fluid supplement (OFS) based on the electrolyte and nutrient composition of amniotic fluid. MATERIALS AND METHODS Preterm pigs (92% of term) received a combination of PN (6 mL/kg-h) and 4 mL/kg-h of supplemental fluid as an experimental OFS (n = 9), lactated Ringer's either enterally (n = 10) or intravenously (n = 8). Outcome measures after 96 hours were weight gain, blood chemistry, organ weights, and small intestine mass and brush-border membrane carbohydrases. RESULTS The OFS did not improve weight gain compared with providing lactated Ringer's orally or intravenously, or increase serum urea nitrogen values, but resulted in higher serum total and low-density lipoprotein cholesterol, as well as improved glucoregulation and heavier intestines, livers, kidneys, and brains and lighter lungs. CONCLUSIONS Providing supplemental fluid and electrolytes during PN either intravenously or orally increases weight gain after preterm birth. An oral fluid supplement based on amniotic fluid may accelerate development and maturation of organs critical for extrauterine life after preterm birth and may enhance neurodevelopment.
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Affiliation(s)
- Kirsten Berding
- Health and Sport Science, University of Memphis, Memphis, Tennessee, USA
| | - Patty Makarem
- Health and Sport Science, University of Memphis, Memphis, Tennessee, USA
| | - Brittany Hance
- Health and Sport Science, University of Memphis, Memphis, Tennessee, USA
| | - Anne Marie Dixen Axel
- Institute of Basic Animal and Veterinary Sciences, Copenhagen University, Frederiksberg C, Denmark
| | - Vikki Nolan
- Public Health, University of Memphis, Memphis, Tennessee, USA
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Velasco Benítez CA, Farfán Cruz G. Aumento de peso después de soporte nutricional en una unidad de cuidado intensivo neonatal. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v62n3sup.40899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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