SMOF 脂质乳剂在极早产儿中的使用并不影响无支气管肺发育不良存活率。

Use of SMOF lipid emulsion in very preterm infants does not affect the incidence of bronchopulmonary dysplasia-free survival.

机构信息

Department of Pediatrics, CHU de Québec-Université, Laval, Québec, Canada.

Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montréal, Canada.

出版信息

JPEN J Parenter Enteral Nutr. 2022 Nov;46(8):1892-1902. doi: 10.1002/jpen.2380. Epub 2022 May 8.

DOI:10.1002/jpen.2380

PMID:35403244

Abstract

BACKGROUND

We aim to assess whether the docosahexaenoic acid (DHA)-containing lipid emulsion (LE) SMOFlipid 20% (Fresenius Kabi Canada Ltd) is associated with bronchopulmonary dysplasia (BPD)-free survival at 36 weeks' postmenstrual age in very preterm infants.

METHODS

This cohort study is nested in the MOBYDIck randomized clinical trial (NCT02371460), which investigated the effect of maternal DHA supplementation on BPD-free survival in breastfed very preterm infants born between 23 0/7 and 28 6/7 weeks' gestation in 16 Canadian neonatal intensive care units (2015-2018). Parenteral SMOF-LE was given to the infants according to the sites' routine care protocols. Relative risks (RRs) were estimated using a modified Poisson regression model with generalized estimating equations taking into account recruitment site, multiple birth, DHA supplementation, birth weight, sex, and gestational age.

RESULTS

Among 528 infants (mean gestational age, 26.5 weeks [SD, 1.6]), 272 received SMOF-LE. Overall, 56.7% of the infants in the SMOF-LE group and 59.7% infants in the non-SMOF-LE group survived without BPD (adjusted RR, 0.94 [95% CI, 0.77-1.14]; P = 0.51). BPD rates were 39.3% in the SMOF-LE group vs 34.1% in the non-SMOF-LE group (adjusted RR, 1.10 [95% CI, 0.82-1.47]; P = 0.53). Severe BPD rates were 31.8% in the SMOF-LE group vs 28.8% in the non-SMOF-LE group (adjusted P = 0.59). Mortality was not significantly different between the SMOF-LE (6.7%) and non-SMOF-LE groups (9.5%; adjusted P = 0.40).

CONCLUSION

In very preterm infants, intravenous DHA-containing SMOF-LE during the neonatal period was not associated with BPD-free survival.

摘要

背景

我们旨在评估二十二碳六烯酸（DHA）含脂质乳剂（LE）SMOFlipid 20%（费森尤斯卡比加拿大有限公司）是否与极低出生体重儿生后 36 周支气管肺发育不良（BPD）无生存相关。

方法

该队列研究嵌套于 MOBYDIck 随机临床试验（NCT02371460）中，该试验研究了母体 DHA 补充对 23 0/7 至 28 6/7 周胎龄、母乳喂养的极低出生体重儿 BPD 无生存的影响，在 16 家加拿大新生儿重症监护病房进行（2015-2018 年）。根据各研究点的常规治疗方案，给予婴儿肠外 SMOF-LE。采用广义估计方程修正泊松回归模型，考虑招募地点、多胎妊娠、DHA 补充、出生体重、性别和胎龄，估计相对风险（RR）。

结果

在 528 例婴儿（平均胎龄 26.5 周[标准差 1.6]）中，272 例接受 SMOF-LE。总体而言，SMOF-LE 组 56.7%的婴儿和非 SMOF-LE 组 59.7%的婴儿无 BPD 存活（调整 RR，0.94[95%CI，0.77-1.14]；P=0.51）。SMOF-LE 组 BPD 发生率为 39.3%，非 SMOF-LE 组为 34.1%（调整 RR，1.10[95%CI，0.82-1.47]；P=0.53）。SMOF-LE 组严重 BPD 发生率为 31.8%，非 SMOF-LE 组为 28.8%（调整 P=0.59）。SMOF-LE（6.7%）和非 SMOF-LE 组（9.5%）的死亡率无显著差异（调整 P=0.40）。