Division of Neonatology, Polytechnic University of Marche, Salesi Children's Hospital, Via Corridoni 11, 60123, Ancona, Italy.
Department of Clinical and Experimental Medical Sciences, University of Udine, Piazzale Kolbe 3, 33100, Udine, Italy.
Clin Nutr. 2019 Oct;38(5):2319-2324. doi: 10.1016/j.clnu.2018.10.009. Epub 2018 Oct 16.
BACKGROUND & AIMS: Long chain n-3 fatty acids (n-3 LCPUFA) play a pivotal role during central nervous system development and the provision of docosahexaenoic acid (DHA) is recommended for the preterm infant. However, there are concerns that oral fish oil, which is a good source of DHA, may adversely affect growth of preterm infants, as it decreases arachidonic acid (ARA). It has been about ten years since fish oil was added to the fat blend of intravenous (IV) lipid emulsions (LE) but information on growth and other clinical outcomes of preterm infants is still scarce. We studied the effect of fish oil containing IV LE vs standard IV LE on growth in a large cohort of preterm infants who received routine parenteral nutrition (PN).
We retrospectively reviewed growth data of 546 preterm infants with a birth weight (BW) < 1250 g consecutively admitted to our NICU between Oct-2008 and Jun-2017 who received PN starting from the first day of life. Individual patients received only one of 5 commercially available IV LE. For the purpose of this study we grouped the patients who received the fish oil containing LE (IV-FO) and those who received conventional LE (CNTR). We compared PN and enteral nutrition (EN) intakes, and growth from birth to 36 weeks post-menstrual age (W PMA).
Demographics, birth data and the incidence of the main complications of prematurity were similar between the two groups (IV-FO: n = 240, Gestational age (GA) 197 ± 16 d, BW 942 ± 181 g; CNTR: n = 237, GA 199 ± 17 d, BW 960 ± 197 g). No difference was found in PN and EN energy and macronutrient intakes from birth to 36W PMA, as well as in the proportion of human milk to infant milk formula. Weight gain from the regained BW to 36W PMA was slightly but significantly higher in IV-FO group: 17.3 ± 2.8 and 16.8 ± 2.7 g∙kg∙d, IV-FO and CNTR respectively (p = 0.03). There was no difference in length gain and head growth nor in body size at 36W PMA between the two groups.
The use of IV fish oil did not negatively affect weight gain in a cohort of preterm infants. Large randomized controlled trials are needed to assess the effect of IV fish oil on the complication of prematurity and on selected domains of infant development.
长链 n-3 脂肪酸（n-3 LCPUFA）在中枢神经系统发育过程中发挥关键作用，建议为早产儿提供二十二碳六烯酸（DHA）。然而，人们担心口服鱼油作为 DHA 的良好来源，可能会通过降低花生四烯酸（ARA）而对早产儿的生长产生不利影响。自十年前开始，鱼油已添加到静脉内（IV）脂肪乳剂（LE）的脂肪混合物中，但有关早产儿生长和其他临床结局的信息仍然很少。我们研究了富含鱼油的 IV LE 与标准 IV LE 对接受常规肠外营养（PN）的大量早产儿生长的影响。
我们回顾性分析了 2008 年 10 月至 2017 年 6 月期间连续收治的胎龄（GA）<1250g 的 546 例早产儿的生长数据，这些早产儿在出生后第一天即开始接受 PN。每位患者仅接受 5 种市售 IV LE 中的一种。为了进行这项研究，我们将接受含鱼油 LE（IV-FO）的患者和接受常规 LE（CNTR）的患者进行分组。我们比较了从出生到 36 周校正胎龄（W PMA）的 PN 和肠内营养（EN）摄入量以及生长情况。
两组的人口统计学、出生数据和早产儿主要并发症的发生率相似（IV-FO：n=240，GA 197±16d，BW 942±181g；CNTR：n=237，GA 199±17d，BW 960±197g）。从出生到 36W PMA，PN 和 EN 的能量和宏量营养素摄入量以及人乳与婴儿配方奶的比例均无差异。从恢复 BW 到 36W PMA 的体重增加在 IV-FO 组中略高但具有统计学意义：17.3±2.8 和 16.8±2.7g∙kg∙d，IV-FO 和 CNTR 分别（p=0.03）。两组在 36W PMA 时的身长增长、头围增长和体型大小均无差异。
在接受 PN 的早产儿队列中，使用 IV 鱼油并未对体重增加产生负面影响。需要进行大规模随机对照试验来评估 IV 鱼油对早产儿并发症和婴儿发育特定领域的影响。
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