Very low birth weight preterm infant complications where parenteral nutrition is soy or fish oil-based: A retrospective study in Shanghai

Background and objectives: To examine whether a parenteral mixed lipid emulsion containing fish oil reduces the incidence of cholestasis, retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW, birth weight <1500 g) infants.

Methods and study design: This retrospective study was conducted in the neonatal intensive care unit of the Children's Hospital of Fudan University. Patients received either a soybean and medium-chain oil (MCT)-based lipid emulsion (Lipofundin) or a mixed lipid emulsion consisting of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) as parenteral nutrition. The primary outcomes were cholestasis, ROP and BPD, and the secondary outcomes were necrotizing enterocolitis (NEC) and sepsis.

Results: A total of 149 premature infants (78 in the soybean oil group and 71 in the fish oil group) were included in this study. Multivariate logistic regression analysis showed that gestational age was associated with the incidence of ROP [odds ratio: 0.446, 95% confidence interval (CI): 0.332-0.576, p<0.001] and BPD [odds ratio: 0.428, 95% CI: 0.316-0.555, p<0.001]. The type of lipid emulsion had no statistically significant effect on any other neonatal morbidity.

Conclusions: Both fish oil-containing and soybean oil-based parenteral lipid emulsions are safe and well-tolerated by preterm infants. However, the use of the SMOF lipid emulsion did not significantly reduce the incidence of cholestasis, ROP and BPD in VLBW infants.