Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):152-161. doi: 10.1002/jpen.1172. Epub 2018 Apr 21.
Infants born prematurely are at risk of a deficiency in ω-6 and ω-3 long-chain polyunsaturated fatty acids (LC-PUFAs) arachidonic acid (AA) and docosahexaenoic acid (DHA). We investigated how fatty acids from breast milk and parenteral lipid emulsions shape serum LC-PUFA profiles in extremely preterm infants during early perinatal life.
Ninety infants born < 28 weeks gestational age were randomized to receive parenteral lipids with or without the ω-3 LC-PUFAs eicosapentaenoic acid (EPA) and DHA (SMOFlipid: Fresenius Kabi, Uppsala, Sweden, or Clinoleic: Baxter Medical AB, Kista, Sweden, respectively). The fatty acid composition of infant serum phospholipids was determined from birth to postmenstrual age 40 weeks, and in mother's milk total lipids on postnatal day 7. Enteral and parenteral intake of LC-PUFAs was correlated with levels in infant serum.
Infants administered parenteral ω-3 LC-PUFAs received 4.4 and 19.3 times more DHA and EPA, respectively, over the first 2 weeks of life. Parenteral EPA but not DHA correlated with levels in infant serum. We found linear relationships between dietary EPA and DHA and infant serum levels in the Clinoleic (Baxter Medical AB) group. The volume of administered SMOFlipid (Fresenius Kabi) was inversely correlated with serum AA, whereas Clinoleic (Baxter Medical AB) inversely correlated with serum EPA and DHA.
There appears to be no or low correlation between the amount of DHA administered parenterally and levels measured in serum. Whether this observation reflects serum phospholipid fraction only or truly represents the amount of accreted DHA needs to be investigated. None of the parenteral lipid emulsions satisfactorily maintained high levels of both ω-6 and ω-3 LC-PUFAs in infant serum.
早产儿存在ω-6 和 ω-3 长链多不饱和脂肪酸（LC-PUFA）亚油酸（AA）和二十二碳六烯酸（DHA）缺乏的风险。我们研究了母乳和肠外脂质乳剂中的脂肪酸如何在极早产儿生命早期围生期内塑造其血清 LC-PUFA 谱。
90 名胎龄<28 周的婴儿被随机分为接受含或不含 ω-3 LC-PUFA 二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）的肠外脂质的两组（SMOFlipid：Fresenius Kabi，Uppsala，瑞典或 Clinoleic：Baxter Medical AB，Kista，瑞典）。从出生到产后 40 周时，测定婴儿血清磷脂中的脂肪酸组成，并在产后第 7 天测定母乳总脂质中的脂肪酸组成。肠内和肠外 LC-PUFA 的摄入与婴儿血清中的水平相关。
接受肠外 ω-3 LC-PUFA 的婴儿在生命的前 2 周内分别接受了 4.4 倍和 19.3 倍的 DHA 和 EPA。肠外 EPA 而不是 DHA 与婴儿血清中的水平相关。我们发现，在 Clinoleic（Baxter Medical AB）组中，饮食中的 EPA 和 DHA 与婴儿血清水平之间存在线性关系。给予 SMOFlipid（Fresenius Kabi）的量与血清 AA 呈负相关，而 Clinoleic（Baxter Medical AB）与血清 EPA 和 DHA 呈负相关。
给予的 DHA 量与血清中测量的水平之间似乎没有相关性或相关性低。这种观察结果是仅反映血清磷脂部分，还是真正代表蓄积的 DHA 量，尚需进一步研究。没有一种肠外脂质乳剂能在婴儿血清中同时维持高浓度的 ω-6 和 ω-3 LC-PUFA。
