Mixed oil emulsion improves outcomes in premature infants

The administration of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) in very preterm (VPI; <32 weeks) and very low birthweight infants (VLBWI; <1,500 g) helps lower peak levels of plasma total bilirubin (TB), direct bilirubin (DB), alkaline phosphatase (ALP), and triglycerides (TG) during hospitalization, as shown in a recent study.

“SMOF has better lipid tolerance, reduces the incidence of parenteral nutrition-associated cholestasis (PNAC) and metabolic bone disease of prematurity (MBDP), and exerts more benefits in preterm infants with gestational age <28 weeks,” the investigators said.

A total of 465 VPIs or VLWIs, admitted to the neonatal intensive care unit of five tertiary hospitals in China from 1 March 2021 to 31 December 2021, were randomized to receive either medium-chain triglycerides/long-chain triglycerides (MCT/LCT; n=231) or SMOF (n=234).

The investigators analysed and compared the clinical features, biochemical indexes, nutrition support therapy, and complications between the two groups.

Perinatal data, hospitalization, parenteral and enteral nutrition support did not significantly differ between groups (p>0.05). [Eur J Clin Nutr 2023;77:823-832]

The SMOF group had a lower incidence of neonates with a peak value of total bilirubin (TB) >5 mg/dL (25.6 percent vs 36.4 percent), direct bilirubin (DB) ≥2 mg/dL (6.0 percent vs 11.3 percent), alkaline phosphatase (ALP) >900 IU/L (3.0 percent vs 7.4 percent), and triglycerides (TG) >3.4 mmol/L (1.7 percent vs 5.6 percent) than the MCT/LCT group.

In univariate analysis, the incidence of PNAC (p=0.043) and MBDP (p=0.029) at <28 weeks was lower in the SMOF group, but no significant between-group differences were observed in the incidence of PNAC (p=0.0177) and MBDP (p=0.991) at >28 weeks.

In multivariate analysis, the SMOF group also had a lower incidence of PNAC (adjusted risk ratio [aRR], 0.38, 95 percent confidence interval [CI], 0.20‒0.70; p=0.002) and MBDP (aRR, 0.12, 95 percent CI, 0.19‒0.81; p=0.029) than the MCT/LCT group.

Additionally, no between-group differences were found in the incidence of patent ductus arteriosus, feeding intolerance, necrotizing enterocolitis (Bell’s stage ≥1), late-onset sepsis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity, and extrauterine growth retardation (p>0.05).

In earlier studies, SMOF was shown to improve the long-tern neurocognitive function of preterm infants. Further studies must be conducted to confirm the benefits of using SMOF. [J Perinatol 2019;39:1118-1124; Am J Perinatol 2020;37:1130-1133]

“According to the literature review, [the current] study is the largest prospective multicentre randomized controlled study comparing MCT/LCT and SMOF, with large sample size and reliable data,” the investigators said. “Since the five centres are distributed in five different provinces of China, their treatment populations may be representative.”

However, this study has certain limitations. First, it lacked a double-blind design. Second, the analysis of MBDP did not consider the dose and administration mode of certain supplementations between the two groups. Finally, the parenteral nutrition protocol did not follow the ESPGHAN/ESPEN/ESPR/CSPEN 2018 guidelines, thus limiting the generalizability of the findings.