Does intravenous fish oil affect the growth of extremely low birth weight preterm infants on parenteral nutrition?

Biagetti, Chiara; Correani, Alessio; D’Ascenzo, Rita; Bellagamba, Maria Paola; Marchionni, Paolo; Antognoli, Luca; Pompilio, Adriana; Cogo, Paola; Carnielli, Virgilio P.

doi:10.1016/j.clnu.2018.10.009

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…However, they did not focus on VLBW and ELBW infants. More recently, original studies including observational studies [ 32 – 39 ] and RCTs [ 19 – 29 ] have begun to focus on the prevention effect of fish oil-containing lipid emulsions on VLBW infants, but their results vary. Our meta-analysis provides an objective argument that fish-oil containing lipid emulsions can decrease occurrence of PNAC in VLBW infants.…”

Section: Discussionmentioning

confidence: 99%

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

Zou

Zhu

et al. 2022

World J Pediatr

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Background The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis (PNAC) in very low birth weight (VLBW) infants is not known. Thus, we conducted a meta-analysis to identify any prevention effect. Methods PubMed, EMBASE, and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants. Revman 5.3 was used to synthesize the results. A fixed-effect model was used to summarize the data when the heterogeneity was non-significant (I2 < 50%), and a random-effects model was used when the heterogeneity was significant (I2 > 50%). Results Of 728 articles, 11 randomized controlled trials met the inclusion criteria. The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio (RR) = 0.53, 95% confidence interval (CI) 0.36–0.80, P = 0.002. The heterogeneity was non-significant with I2 = 23%. Subgroup analysis based on parenteral nutrition duration and median birth weight was performed. The synthesis results for patients with parenteral nutrition duration exceeding 14 days revealed I2 = 35% (P = 0.15) and pooled RR = 0.47, 95% CI 0.30–0.73, P = 0.0008; and for patients with duration less than 14 days revealed I2 = 0% (P = 0.72) and pooled RR = 1.14, 95% CI 0.39–3.35, P = 0.81. The synthesis for patients with birth weight more than 1000 g revealed I2 = 0% (P = 0.41) and pooled RR = 0.55, 95% CI 0.26–1.18, P = 0.12; and for patients with birth weight below 1000 g revealed I2 = 44% (P = 0.11) and pooled RR = 0.53, 95% CI 0.33–0.85, P = 0.009. Conclusions The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the available original randomized controlled trial studies, especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants. Future studies should be performed before a definitive conclusion can be established.

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Section: Discussionmentioning

confidence: 99%

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

Zou

Zhu

et al. 2022

World J Pediatr

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“…These data were published elsewhere. 22 Selected interventions and respirator/ventilator parameters during the first week of life are reported in Table 1. No differences in the duration of mechanical ventilation and CPAP from birth to 36 W between IV FO and CNTR infants were found (MV: 5 [1-13] vs 5 [1][2][3][4][5][6][7][8][9][10][11][12] days, P = .9; CPAP: 24 vs 21 days, P = .6, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…18 Weight gain was slightly higher in patients who received IV FO even if lipogenesis could be significantly reduced. 22 If reducing plasma lipids seems to be desirable in adults, the same may not apply to the fast-growing preterm infant in whom lipogenesis plays a key role in lipid biosynthesis which in turn is extremely important for lung function (surfactant synthesis), brain maturation (myelinization) and other growth-related phenomena. This retrospective study has limitations and it carries the risks of inherent biases.…”

Section: Discussionmentioning

confidence: 99%

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Oxygen saturation to fraction of inspired oxygen ratio in preterm infants on routine parenteral nutrition with conventional or fish oil containing lipid emulsions

Correani

Dell’Orto

Nobile

et al. 2020

Pediatric Pulmonology

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Introduction The benefits of intravenous (IV) fish oil (FO), as a source of n‐3 long‐chain polyunsaturated fatty acids, on lung growth in preterm infants, remain controversial. Aim To evaluate if IV FO improves lung growth in small preterm infants on routine parenteral nutrition (PN). Materials and Methods We retrospectively reviewed prospectively collected data of preterm infants with a birth weight <1250 g who received routine PN from birth. We compared patients who received FO containing IV lipid emulsions with infants who received conventional emulsions (CNTR). The oxygen saturation (SpO2) to a fraction of inspired oxygen (FiO2) ratio (SFR) at 36 weeks (W) of gestation was chosen as the primary outcome variable to assess lung growth. Results Four hundred and seventy‐seven infants were studied: 240 received IV FO and 237 CNTR. While exposure to antenatal glucocorticoids was higher in IV FO group than in CNTR (95 vs 90%, P = .04), there were no differences in birth data, enteral and parenteral nutrition intakes, ventilator supports and drug therapies. The incidence of the most common complications of prematurity at 36 W was not different (bronchopulmonary dysplasia was 27 vs 21% in IV FO vs CNTR infants, P = .1). Weight gain from birth to 36 W was marginally, but significantly, higher (+0.5 g/kg/d, P = .03) in IV FO group vs CNTR. SFR increased from 32 W to 36 W in all study patients (P < .001). IV FO infants had significantly lower SpO2 from 33 W to 35 W (P < .001) and lower (worse) SFR at 36 W (432 ± 57 vs 444 ± 51, P = .026) compared to CNTR. Conclusion Contrary to our hypothesis, the use of FO containing IV lipid emulsions for the routine PN of the preterm infant did not improve lung growth compared to the infants who received conventional IV lipid emulsions.

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“…Marine oils have very low ARA levels, and it is suggested that there could be possible negative effects on growth [9] due to the further decline in ARA along the early neonatal period [10]. However, in a recent retrospective study in preterm infants, it was concluded that fish oil did not negatively affect weight gain [11]. Sufficient ARA supply may be important for other reasons.…”

Section: Introductionmentioning

confidence: 99%

Plasma Oxidative Status in Preterm Infants Receiving LCPUFA Supplementation: A Pilot Study

et al. 2020

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After birth, preterm infants are deficient in arachidonic acid (ARA), docosahexaenoic acid (DHA), and antioxidants, increasing their risk of oxidative stress-related pathologies. The principal aim was to evaluate if supplementation with long-chain polyunsaturated fatty acids (LCPUFAs) improves antioxidant defenses. In total, 21 preterm infants were supplemented with ARA and DHA in a 2:1 ratio (ARA:DHA-S) or with medium-chain triglycerides (MCT-S). Plasma n-3 and n-6 LCPUFAs were measured at birth, postnatal day 28, and 36 weeks of postmenstrual age (36 WPA) by gas chromatography–mass spectroscopy. Plasma antioxidants (glutathione (GSH), catalase, and thiols) and oxidative damage biomarkers (malondialdehyde (MDA), carbonyls) were analyzed at the same time points by spectrophotometry, and scores of antioxidant status (Antiox-S) and oxidative damage (Proxy-S) were calculated. At 36 WPA, linoleic acid (LA) and dihomo-γ-linolenic acid (DGLA) were decreased in ARA:DHA-S compared to the MCT-S group (LA: ARA:DHA-S = 18.54 ± 1.68, MCT-S = 22.80 ± 1.41; p = 0.018; DGLA: ARA:DHA-S = 1.68 ± 0.38, MCT-S = 2.32 ± 0.58; p = 0.018). Furthermore, α-linolenic acid (ALA) was increased in ARA:DHA-S (ARA:DHA-S = 0.52 ± 0.33, MCT-S = 0.22 ± 0.10; p = 0.018). Additionally, LA:DHA ratio was decreased in the ARA:DHA-S compared to control group (ARA:DHA-S = 6.26 ± 2.35, MCT-S = 8.21 ± 2.65; p = 0.045). By the end of supplementation (36 WPA), catalase, thiol groups, and Antiox-S were significantly higher in neonates receiving ARA:DHA-S compared to those receiving MCT-S, with no differences in oxidative stress biomarkers. In conclusion, ARA:DHA supplementation in preterm neonates resulted in an overall improvement in antioxidant to oxidant balance and a decrease in early fatty acid precursors of the n-6 relative to the n-3 pathway. These effects may reduce oxidative stress and inflammation.

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Does intravenous fish oil affect the growth of extremely low birth weight preterm infants on parenteral nutrition?

Cited by 9 publications

References 22 publications

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants: a meta-analysis

Oxygen saturation to fraction of inspired oxygen ratio in preterm infants on routine parenteral nutrition with conventional or fish oil containing lipid emulsions

Plasma Oxidative Status in Preterm Infants Receiving LCPUFA Supplementation: A Pilot Study

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