Using Parenteral Fish Oil From Birth May Improve Short and Long Term Outcome in Preterm Infants

Document Type : Original Article

Authors

1 Dr Behçet Uz Children's Diseases and Surgery Training and Research Hospital, Neonatal Department, Izmir, Turkey

2 Altınbas University Faculty of Medicine Department of Child Health and Disease, Neonatal Department, Istanbul, Turkey

10.22038/ijn.2024.81109.2566

Abstract

Background: Lipids are a crucial component of parenteral nutrition in its entirety. This study aimed to compare the short—and long-term outcomes of lipid solutions containing fish oil and standard parenteral lipid solutions in total parenteral nutrition of premature neonates.
Methods: Preterm infants weighing less than 1500 grams or 32 weeks gestation admitted to Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital Neonatal Intensive Care Unit between January 2018 and January 2020 were included in this retrospective cross-sectional study. Infants receiving only 3 g/kg/day Clinoleic were enrolled in Group 2; infants receiving 1 g/kg/day Omegaven plus 2 g/kg/day Clinoleic were enrolled in Group 1. Weight at discharge, laboratory data (liver enzymes, bilirubin levels), and long-term results were compared.
Results: The study comprised 70 newborns, and 35 of them were in Group 1. Group 1 had a considerably lower direct bilirubin level (d bil p valueu; 1st week p=0.03, 2nd week p=0.87, 3rd week p=0.02). The omegaven group had a considerably higher weight upon discharge (p=0.02). Long-term neurodevelopmental results did not differ across the groups (MDI score p=0.33, PDI score p=0.11, NDI positivity p=1.00, MDP p=0.81).
Conclusion: We demonstrated that the weight at discharge and laboratory measurements improved with Omegaven support. Early exposure to very high levels of oxidative stress may cause infants to employ their antioxidant system as a parenteral support system.
 
 

Keywords

References

  1. Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al; ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European society of paediatric gastroenterology, hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85-91.
  2. Lapillonne A, Groh-Wargo S, Gonzalez CH, Uauy R. Lipid needs of preterm infants: updated recommendations. J Pediatr. 2013;162(3 Suppl): S37-47.
  3. Lapillonne A. Enteral and parenteral lipid requirements of preterm infants. World Rev Nutr Diet. 2014;110:82-98.
  4. Göbel Y, Koletzko B, Böhles HJ, Engelsberger I, Forget D, Le Brun A, et al. Parenteral fat emulsions based on olive and soybean oils: a randomized clinical trial in preterm infants. J Pediatr Gastroenterol Nutr. 2003;37(2):161-167.
  5. Gawecka A, Michalkiewicz J, Kornacka MK, Luckiewicz B, Kubiszewska I. Immunologic properties differ in preterm infants fed olive oil vs soy-based lipid emulsions during parenteral nutrition. JPEN J Parenter Enteral Nutr. 2008; 32(4):448-453.
  6. de Lorgeril M, Salen P. New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids. BMC Med. 2012; 10:50.
  7. Calder PC, Waitzberg DL, Klek S, Martindale RG. Lipids in Parenteral Nutrition: Biological Aspects. JPEN J Parenter Enteral Nutr. 2020;44 Suppl 1:S21-S27.
  8. Koletzko B. Intravenous lipid emulsions for infants: when and which? Am J Clin Nutr. 2012;96(2):225-226.
  9. Fürst P, Kuhn KS. Fish oil emulsions: what benefits can they bring? Clin Nutr. 2000;19(1):7-14.
  10. Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol. 2008;8(5):349-361.
  11. Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics. 2008;121(3):e678-686.
  12. Türkyılmaz C, Bilgen H, Kültürsay N. Turkish Neonatal Society guideline on parenteral nutrition in preterm infants. Turk Pediatri Ars. 2018;53(Suppl 1):S119-S127.
  13. Blauw-Hospers CH, Hadders-Algra M. A systematic review of the effects of early intervention on motor development. Dev Med Child Neurol. 2005;47(6): 421-432.
  14. Martin JA, Osterman MJ, Sutton PD. Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System. NCHS Data Brief. 2010;(39):1-8.
  15. Harris SR, Megens AM, Backman CL, Hayes VE. Stability of the bayley II scales of infant development in a sample of low-risk and high-risk infants. Dev Med Child Neurol. 2005;47(12):820-823. Erratum in: Dev Med Child Neurol. 2006;48(5):398.
  16. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: a systematic review and meta-analysis. J Nutr. 2015;145(2):277-283.
  17. Clayton PT, Whitfield P, Iyer K. The role of phytosterols in the pathogenesis of liver complications of pediatric parenteral nutrition. Nutrition. 1998;14(1):158-164.
  18. Fallon EM, Le HD, Puder M. Prevention of parenteral nutrition-associated liver disease: role of omega-3 fish oil. Curr Opin Organ Transplant. 2010;15(3):334-340.
  19. Strang BJ, Reddix BA, Wolk RA. Improvement in parenteral nutrition-associated cholestasis with the use of omegaven in an infant with short bowel syndrome. Nutr Clin Pract. 2016;31(5):647-653.
  20. Skouroliakou M, Konstantinou D, Agakidis C, Delikou N, Koutri K, Antoniadi M, et al. Cholestasis, bronchopulmonary dysplasia, and lipid profile in preterm infants receiving MCT/ω-3-PUFA-containing or soybean-based lipid emulsions. Nutr Clin Pract. 2012;27(6):817-824.
  21. Chang MI, Puder M, Gura KM. The use of fish oil lipid emulsion in the treatment of intestinal failure associated liver disease (IFALD). Nutrients. 2012;4(12):1828-1850.
  22. Puder M, Valim C, Meisel JA, Le HD, de Meijer VE, Robinson EM, et al. Parenteral fish oil improves outcomes in patients with parenteral nutrition-associated liver injury. Ann Surg. 2009;250(3): 395-402.
  23. Goulet O, Joly F, Corriol O, Colomb-Jung V. Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transplant. 2009;14(3):256-261.
  24. Unal S, Demirel N, Erol S, Isik DU, Kulali F, Iyigun F, et al. Effects of two different lipid emulsions on morbidities and oxidant stress statuses in preterm infants: an observational study. J Matern Fetal Neonatal Med. 2018;31(7):850-856.
  25. Lauritzen L, Hansen HS, Jørgensen MH, Michaelsen KF. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res. 2001;40(1-2):1-94.
  26. Rivera JC, Sapieha P, Joyal JS, Duhamel F, Shao Z, Sitaras N, et al. Understanding retinopathy of prematurity: update on pathogenesis. Neonatology. 2011;100(4):343-353.
  27. Yang R, Ding H, Shan J, Li X, Zhang J, Liu G, et al. Association of fish oil containing lipid emulsions with retinopathy of prematurity: a retrospective observational study. BMC Pediatr. 2022;22(1):113.
  28. Deshpande GC, Simmer K, Mori T, Croft K. Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks' gestation) neonates: a randomised controlled trial. J Pediatr Gastroenterol Nutr. 2009;49(5):619-625.
  29. Najm S, Löfqvist C, Hellgren G, Engström E, Lundgren P, Hård AL, et al. Effects of a lipid emulsion containing fish oil on polyunsaturated fatty acid profiles, growth and morbidities in extremely premature infants: A randomized controlled trial. Clin Nutr ESPEN. 2017;20:17-23.
  30. Yildizdas HY, Poyraz B, Atli G, Sertdemir Y, Mert K, Ozlu F, et al. Effects of two different lipid emulsions on antioxidant status, lipid peroxidation and parenteral nutrition- related cholestasis in premature babies, a randomized-controlled study. Pediatr Neonatol. 2019;60(4):359-367.
  31. Kapoor V, Malviya MN, Soll R. Lipid emulsions for parenterally fed term and late preterm infants. Cochrane Database Syst Rev. 2019;6(6):CD013171.

 

Iranian Journal of Neonatology
Volume 15, Issue 4
October 2024
Pages 2-9

Files

Share

How to cite

Statistics