Deshpande Girish, Simmer Karen, Deshmukh Mangesh, Mori Trevor A, Croft Kevin D, Kristensen Judy
*Department of Neonatal Paediatrics, King Edward Memorial Hospital Western Australia †School of Medicine and Pharmacology, University of Western Australia ‡Department of Pharmacy, King Edward Memorial Hospital for Women, Perth, Australia.
J Pediatr Gastroenterol Nutr. 2014 Feb;58(2):177-82. doi: 10.1097/MPG.0000000000000174.
Fat emulsions used in Australia for parenteral nutrition in preterm neonates have been based on either soybean oil or olive oil (OO). OO lipid Clinoleic has a high ratio of n-6 to n-3 fatty acids (9:1); this may not be ideal for long-chain polyunsaturated fatty acids supply. Newly available SMOFlipid has an appropriate ratio of n-6 to n-3 fatty acids (2.5:1). SMOFlipid also contains OO (25%), coconut oil (30%), and soybean oil (30%). The aims of the study were to evaluate the safety of the SMOFlipid and to test the hypothesis that SMOFlipid would lead to increased omega-3 long-chain polyunsaturated fatty acid levels and reduced oxidative stress as compared with Clinoleic in preterm neonates (<30 weeks).
Preterm neonates (23-30 weeks) were randomised to receive Clinoleic or SMOFlipid emulsion for 7 days. Investigators and outcome assessors were masked to allocation. Plasma F2-isoprostanes (lipid peroxidation marker), red blood cell fatty acids, and vitamin E were measured before and after the study. Blood culture positive sepsis and growth were monitored for safety.
Thirty of 34 participants completed the study. Both emulsions were well tolerated without any adverse events. F2-isoprostane levels were reduced in the SMOFlipid group as compared with baseline. Eicosapentanoic acid and vitamin E levels were significantly increased in the SMOFlipid group. Oleic acid and linoleic acid levels were increased in both groups. No significant differences were noted in poststudy docosahexaenoic acid levels in both groups despite higher levels of docosahexaenoic acid in SMOFlipid.
SMOFlipid was safe, well tolerated, and showed beneficial effect in terms of reduction of oxidative stress by reducing lipid peroxidation levels in high-risk preterm neonates.
澳大利亚用于早产儿肠外营养的脂肪乳剂以大豆油或橄榄油（OO）为基础。OO脂质Clinoleic的n-6与n-3脂肪酸比例很高（9:1）；这对于长链多不饱和脂肪酸的供应可能并不理想。新上市的SMOFlipid具有合适的n-6与n-3脂肪酸比例（2.5:1）。SMOFlipid还含有OO（25%）、椰子油（30%）和大豆油（30%）。本研究的目的是评估SMOFlipid的安全性，并检验以下假设：与Clinoleic相比，SMOFlipid可使孕周小于30周的早产儿体内ω-3长链多不饱和脂肪酸水平升高，氧化应激降低。
将孕周23 - 30周的早产儿随机分为两组，分别接受Clinoleic或SMOFlipid脂肪乳剂，为期7天。研究人员和结果评估人员对分组情况不知情。在研究前后分别测量血浆F2-异前列腺素（脂质过氧化标志物）、红细胞脂肪酸和维生素E。监测血培养阳性败血症及生长情况以评估安全性。
34名参与者中有30名完成了研究。两种脂肪乳剂耐受性良好，未出现任何不良事件。与基线相比，SMOFlipid组的F2-异前列腺素水平降低。SMOFlipid组的二十碳五烯酸和维生素E水平显著升高。两组的油酸和亚油酸水平均升高。尽管SMOFlipid中的二十二碳六烯酸水平较高，但两组研究后的二十二碳六烯酸水平无显著差异。
SMOFlipid安全、耐受性良好，在高危早产儿中通过降低脂质过氧化水平减轻氧化应激方面显示出有益作用。
