Peck Lauren H, Prusakov Pavel, Mezoff Ethan A
J Pediatr Pharmacol Ther. 2021;26(8):841-849. doi: 10.5863/1551-6776-26.8.841. Epub 2021 Nov 10.
A mixture of soybean, medium-chain triglycerides, olive, and fish oils (SMOF) contains higher α-tocopherol and n-3 polyunsaturated fatty acids and lower phytosterol content compared with conventional soybean oil lipid emulsions (SOLE). We sought to characterize plasma total fatty acid profiles (FAPs) and assess the tolerability of long-term SMOF therapy in extremely preterm infants.
We retrospectively evaluated infants born <28 weeks gestational age who received at least 30 consecutive days of SMOF between July 2016 and June 2019. We evaluated monthly FAPs and biochemical tolerance to SMOF using direct bilirubin (DB) and triglyceride (TG) levels. Growth parameters were evaluated longitudinally until discharge.
Sixteen patients with median gestational age 24 weeks (IQR, 23-25 weeks) received SMOF for median 76 days (IQR, 52-130 days). Fourteen patients had necrotizing enterocolitis (NEC) requiring surgical intervention and 15 patients received SOLE for median 19 days (IQR, 14-26 days) prior to switching to SMOF. Median docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels were elevated, whereas the remaining fatty acid levels fell within reported reference ranges. There were no incidents of essential fatty acid deficiency (triene to tetraene ratio >0.2) or hypertriglyceridemia (TG >200 mg/dL) with a general downtrend in DB after the first month on SMOF. All growth Z-scores declined throughout hospital stay.
Infants who received SMOF had a more pronounced elevation in DHA than EPA, of which the clinical significance remains unknown. Growth Z-scores declined with SMOF but were confounded by a high prevalence of surgically treated NEC.
与传统大豆油脂质乳剂（SOLE）相比，大豆、中链甘油三酯、橄榄油和鱼油混合物（SMOF）含有更高的α-生育酚和n-3多不饱和脂肪酸，且植物甾醇含量更低。我们试图描述血浆总脂肪酸谱（FAPs），并评估极早产儿长期接受SMOF治疗的耐受性。
我们回顾性评估了2016年7月至2019年6月期间出生胎龄<28周且连续至少30天接受SMOF治疗的婴儿。我们使用直接胆红素（DB）和甘油三酯（TG）水平评估每月的FAPs以及对SMOF的生化耐受性。纵向评估生长参数直至出院。
16例中位胎龄24周（四分位间距，23 - 25周）的患者接受SMOF治疗的中位时间为76天（四分位间距，52 - 130天）。14例患者发生坏死性小肠结肠炎（NEC）需要手术干预，15例患者在改用SMOF之前接受SOLE治疗的中位时间为19天（四分位间距，14 - 26天）。二十二碳六烯酸（DHA）和二十碳五烯酸（EPA）的中位水平升高，而其余脂肪酸水平落在报告的参考范围内。在接受SMOF治疗的第一个月后，没有发生必需脂肪酸缺乏（三烯与四烯比值>0.2）或高甘油三酯血症（TG>200 mg/dL）的情况，且DB总体呈下降趋势。在整个住院期间，所有生长Z评分均下降。
接受SMOF治疗的婴儿DHA升高比EPA更明显，其临床意义尚不清楚。SMOF治疗时生长Z评分下降，但因手术治疗的NEC患病率高而受到混淆。
