Abstract
Objective Intravenous lipid infusions improve both short- and long-term outcomes of premature
neonates. However, prolonged infusion of lipids has been implicated in the development
of parenteral nutrition-associated cholestasis (PNAC). We speculated that the multicomponent
SMOFlipid would be hepatoprotective against PNAC.
Study Design This is a retrospective review comparing the incidence and severity of direct hyperbilirubinemia
in preterm infants <1,500 g who were hospitalized for a minimum of 2 weeks during
a 20-month period in which all preterm infants on total parenteral nutrition (TPN)
received fat as Lipofundin with the following 20-month period in which all preterm
infants on TPN received SMOFlipid.
Results Infants in the SMOFlipid period had a lower incidence of PNAC (6 vs. 13%; p = 0.022), lower peak direct bilirubin levels (3.2 vs. 7.1 mg/dL; p = 0.018), and a shorter length of stay (51 vs. 60 days; p = 0.019). The relative risk of developing direct hyperbilirubinemia during the Lipofundin
period was 2.22 (1.1–4.3) as compared with period 1; p = 0.018; NNT-14.
Conclusion SMOFlipid was hepatoprotective in our population of preterm neonates <1,500 g receiving
long-term TPN as compared with those receiving Lipofundin, despite similar levels
of exposure to both intravenous lipid load and duration in the two groups.
Keywords
perinatal nutrition - cholestasis - long chain polyunsaturated fatty acids
