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 advan-tages that the fatty acids provide for premature infant dis-eases have not yet been fully understood. The aim of this study was to evaluate the advantages of SMOFlipid, a lip-id emulsion product that contains omega-3 over other lip-id 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 lip-id 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. There-fore, omega-3-containing lipid emulsion can be highly rec-ommended in premature babies, especially in VLBWI who require TPN support. (JKSPEN 2013;5(2):67-75)

• Keywords: Very low birth weight infant, Total parenteral nutrition, Cholestasis, Retinopathy of prematurity, Omega- 3 fatty acids