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A Multi-Oil Intravenous Lipid Emulsion with Fish Oil: Clinical Outcomes and Red Blood Cell Membrane Polyunsaturated Fatty Acids in Extremely Low Birth Weight Infants.

BACKGROUND
100% soybean oil emulsions (SO100) are associated with poor docosahexaenoic (DHA) and arachidonic acid (ARA) status in extremely low birth weight (ELBW) infants. A multi-oil emulsion with 15% fish oil (FO15) contains more DHA and ARA than SO100. This study compares clinical outcomes, namely growth and fatty acids, in ELBW infants who received SO100 or FO15.


METHODS
This observational study included ELBW infants born between 2014-2019 who survived to discharge and received SO100 or FO15 >7 days. Gas chromatography/mass spectrometry was used to measure erythrocyte fatty acids.


RESULTS
The mean (±SD) gestational age was 27±3 and 26±2 weeks for SO100 (n=43) and FO15 (n=43), respectively (p=0.2). DHA (-0.3±0.10%/week, p=0.026 for FO15 vs. -0.2±0.05%/week, p<0.001 for SO100,) and ARA (-0.8±0.21%/week for FO15 vs. -0.9±0.17%/week for SO100, p<0.001 for both) declined in both groups with no difference between groups (p-interaction >0.7 for both). After controlling for days to reach full feeds, the mean difference in weight z-score trajectories was similar (Est=-0.08, 95% CI -0.82, 0.04, p=0.2), and SO100 was associated with non-significant increased odds for cholestasis (OR 3.1, 95% CI 0.96, 10.2, p=0.059). There was no difference in other common clinical co-morbidities.


CONCLUSIONS
In comparison to infants who received a pure soybean oil emulsion, ELBW infants who received a multi-oil emulsion with 15% fish oil still demonstrated a decline in DHA and ARA. Growth and other clinical outcomes were unchanged. Research is warranted to determine the optimal Iipid emulsion for ELBW infants. This article is protected by copyright. All rights reserved.