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

Abstract

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.

Effect of Global Economic Recession on Regional Autonomy Policy South Sumatra 2022

“…In public administration, the Governor as the provincial leader is a public official who has a political office, he hopes that in the future there will be conformity for regional autonomy that cannot be generalized to each region due to differences in cultural customs and geographical location in each region. In this case, regional income has a relationship with various physical and socioeconomic variables is to identify which variable has the most influence on regional revenue receipts (Zou et al 2022).…”

Lipid emulsions in parenteral nutrition: does it matter?

“…A range of meta-analyses have found compelling clinical benefits for the use of FO in PN from multiple RCTs, which includes the recently published Canadian Critical Care Nutrition guidelines [4 ▪▪ ,31 ▪▪ ,32] (see Table 2 for summary of recent meta-analysis publications on omega-3 ILE sparing trials). To exemplify this, results of the largest meta-analysis [39 ▪▪ ], including 49 RCTs and 3641 patients, showed the use of n-3 PUFAs was associated with 40% fewer infections ( P < 0.00001), approximately 2 days’ shorter hospital stay ( P < 0.00001), about 2 days shorter ICU stay ( P = 0.01), and sepsis was reduced by 56% ( P = 0.0004) [33]. Further cost-effectiveness evaluation using data from this meta-analysis demonstrated that FO-containing ILE reduced costs in the United States and a range of European countries (see data summarized in Figs.…”

“…An added benefit of the omega-3 fatty acid ILEs found in FO is that they increase learning, memory, cognitive well being, and blood flow to the brain [38 ▪ ]. It is also clearly proven that pure FO-LE in PN reduce, and in fact can reverse, the occurrence of cholestasis in very low birth weight and preterm infants [5 ▪▪ ,39 ▪▪ ,40 ▪ ,41].…”

Pemberian Nutrisi Parenteral pada Bayi dan Anak

“…Hasilnya menunjukkan bahwa pemberian emulsi lemak mengandung sh oil dapat menurunkan kejadian PNAC (parenteral nutrition associated cholestasis) secara bermakna (p=0,002) dan hasil analisis subgrup menunjukkan bahwa penurunan PNAC lebih baik pada subjek yang mendapat emulsi lemak tidak lebih dari 14 hari dan pada bayi yang beratnya di bawah 1.000 gram. 22 Selain karbohidrat, protein, dan lemak yang merupakan sumber energi utama bayi dan anak, dibutuhkan juga vitamin dan mineral. Vitamin dan mineral dibutuhkan untuk mempertahankan integritas dan fungsi sistem imun bayi dan anak.…”