J Korean Soc Parenter Enter Nutr.  2013 Aug;5(2):67-75. 10.15747/jkspen.2013.5.2.67.

Effects of SMOFlipid on Prophylaxis of Cholestasis in Premature Very Low Birth Weight Infants

• Kim MJ
• Bae HJ
• Cho YS
• Kim KS
• Kim HS
• Lee HS
• Lee JY
• Kim EK
• Kim HS

• KMID: 2190889
• DOI: http://doi.org/10.15747/jkspen.2013.5.2.67

Abstract

PURPOSE
Very low birth weight infants (VLBWI) are found to have a higher incidence of cholestasis due to long-term total parenteral nutrition (TPN). Although there have been some studies on relationships between omega-3 fatty acids and reduced incidence of cholestasis, the advantages that the fatty acids provide for premature infant diseases have not yet been fully understood. The aim of this study was to evaluate the advantages of SMOFlipid, a lipid emulsion product that contains omega-3 over other lipid emulsion products that do not.
METHODS
The medical records of 182 newborn (127 boys and 55 girls) were reviewed retrospectively between April 2010 and August 2012. These infants were born with a birth weight of <1,500 g and administered either of lipid emulsions (Intra MCT 20% or SMOFlipid) from birth to a full-feeding condition at our neonatal intensive care unit. Cholestasis is defined as serum direct bilirubin (DB) >1.0 mg/dL when total bilirubin (TB) is <5 mg/dL or DB/TB ratio is >20% when TB >5 mg/dL.
RESULTS
The incidence of cholestasis was found to be lower in the SMOFlipid group than in the medium-chain triglyceride/long chain triglyceride (MCT/LCT) group (7.3% [4/55] versus 18.9% [24/127], P=0.046). At the start of lipid emulsion administration (day 0), the baseline bilirubin level showed no significant difference between the two groups. However, the maximum value of DB on days 7~14 was lower in the SMOFlipid group than in the MCT/LCT group (0.8 [0.3~2.2] versus 1.1 [0.3~2.8] mg/dL, P=0.030). The DB/TB ratio was also lower in the SMOFlipid group than in the MCT/LCT group (10.2% [4.9%~40.0%] versus 24.1% [5.1%~62.5%], P=0.002).
CONCLUSION
This study concluded that SMOFlipid was effective in the prevention of cholestasis in VLBWI. Therefore, omega-3-containing lipid emulsion can be highly recommended in premature babies, especially in VLBWI who require TPN support.

Keyword

Very low birth weight infant; Total parenteral nutrition; Cholestasis; Retinopathy of prematurity; Omega-3 fatty acids

MeSH Terms

Bilirubin
Birth Weight
Cholestasis*
Emulsions
Fatty Acids
Fatty Acids, Omega-3
Humans
Incidence
Infant*
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight*
Intensive Care, Neonatal
Medical Records
Parenteral Nutrition, Total
Parturition
Retinopathy of Prematurity
Retrospective Studies
Triglycerides
Bilirubin
Emulsions
Fatty Acids
Fatty Acids, Omega-3