Monash University, Melbourne, Australia.
Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
Eur J Pediatr. 2018 May;177(5):723-731. doi: 10.1007/s00431-018-3112-3. Epub 2018 Feb 14.
Neonatal units have started to switch from using conventional soy-based to alternate lipid emulsions, like SMOFlipid. SMOFlipid has been associated with an improvement in biochemical parameters and delays progression of parenteral nutrition-associated liver disease (PNALD). This retrospective epoch study aimed to compare clinically relevant neonatal outcomes in preterm infants (< 32 weeks), receiving SMOFlipid versus Intralipid. We compared clinical outcomes in two epochs-epoch 1 (Intralipid, October 2013-June 2015) versus epoch 2 (SMOFlipid, July 2015-March 2017). Primary outcome studied was mortality and rates of severe neonatal morbidities. Univariate and multivariate regression was conducted to determine risk for mortality and PNALD. A total of 222 infants (epoch 1, 123 versus epoch 2, 99) were included in the study. A higher incidence of late onset sepsis (56 versus 30%, p < 0.005) was observed in epoch 1. There was no significant difference in mortality or rates of any other severe neonatal morbidity. The type of lipid emulsion did not have a significant effect on mortality or PNALD on regression analysis.
Use of SMOFlipid as the primary lipid emulsion seems to have minimal effect on rates of clinically important neonatal outcomes; however, long-term effects need to be further evaluated. What is Known: • Many neonatal units have started replacing traditional soy-based lipid formulations with SMOFlipid (ω-3 enriched lipid emulsion), as the primary lipid component in parenteral nutrition for preterm infants. • While there is evidence associating improved liver function and balanced essential fatty acid levels in infants receiving SMOFlipid, there is a lack of evidence evaluating relevant clinical outcomes in infants receiving SMOFlipid versus traditional lipid formulations. What is New: • The influence of SMOFlipid on a series of clinical outcomes in an at-risk preterm population is presented. • SMOFlipid appears to be well tolerated in preterm infants with minimal side effects, and some growth benefits seen.
研究比较早产儿（<32 周）使用 SMOFlipid 与 Intralipid 的临床相关结局。方法：回顾性比较两个时期（时期 1：Intralipid，2013 年 10 月-2015 年 6 月；时期 2：SMOFlipid，2015 年 7 月-2017 年 3 月）的临床结局。主要结局是死亡率和严重新生儿发病率。使用单变量和多变量回归来确定死亡率和 PNALD 的风险。结果：共纳入 222 例患儿（时期 1：123 例，时期 2：99 例）。时期 1 中晚发性败血症发生率较高（56% vs 30%，p<0.005）。两组死亡率或其他严重新生儿发病率无显著差异。回归分析表明，不同类型的脂肪乳剂对死亡率或 PNALD 无显著影响。结论：使用 SMOFlipid 作为主要脂肪乳剂似乎对重要的临床新生儿结局发生率影响不大，但仍需进一步评估长期影响。
