Background Total Parenteral nutrition (TPN) is crucial for the survival of premature and sick neonates. However, TPN associated cholestasis (TPNAC) leading to cholestatic cirrhosis is a commonly occurring complication. Since recent findings suggest that fish oil-based LEs appear to be safe and efficacious for the treatment of TPNAC in children, data about its preventive effect on TPNAC in premature neonates could be important.
Purpose This study aimed to compare the effect of two LEs, MCTs/ω-3-PUFAs-enriched (MCTs/ω-3-LE) and soybean-based, on the incidence of TPNAC and lipid profile of preterm infants,
Materials and methods Neonates (GA 23-36 wks) without severe sepsis, congenital infections, or primary liver disease, needing parenteral LEs for at least 7 days, were included in a prospective double-blind controlled study. Infants were randomly assigned in intervention group (IG, n=127) receiving MCTs/ω-3-LE and control group (CG, n=122) receiving soybean-based LE. Biochemical measurements were performed on days of life (DOL) 15, 30, 45 and on discharge.
Results Cholestasis (direct bilirubin>2 mg/dL) was observed in 6.4% infants (3.9% and 9.0% in IG and CG, respectively, p=0.124, OR=0.41, CI=0.14-1.23). The duration of PN was the only factor independently associated with cholestasis (p<0.001, OR=0.934, 95% CI=0.911-0.959). The IG had lower alkaline phosphatase (ALP) at all time points, higher HDL and lower cholesterol-to-HDL ratio on DOL 30 and discharge. Additionally, IG had significantly lower incidence of bronchopulmonary dysplasia and shorter duration of hospitalisation and PN. The type of LE was significant independent predictor of ALP on DOL 15, 45, and discharge as well as of bronchopulmonary dysplasia development.
Conclusions Parenteral MCTs/ω-3-PUFAs-enriched LE is associated with a trend towards a lower incidence of cholestasis and a better lipoprotein profile in preterm infants compared to soybean-based LE. Future research should address the effect of MCTs/ω-3-PUFAs LE on bronchopulmonary dysplasia and osteopenia of prematurity.
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