Abstract

Objective: We aimed to compare the serum liver function tests, cholesterol and triglyceride levels in preterm infants receiving parenteral lipid emulsions based on fish oil or olive oil.

Material and Methods: This retrospective study was performed at Etlik Zübeyde Hanım Women’s Health Training Hospital, Ankara. We reviewed charts of inborn infants, with a gestational age between 25 and 32 weeks and birth weight <1500 grams, who were admitted to the neonatal intensive care unit between 01.01.2015 and 31.12.2015. Infants who received parenteral nutrition ≥ 10 days and were alive on the 28th day were included and grouped regarding the type of lipid emulsion (fish-oil; SMOFlipid®, olive oil; ClinOleic®). The levels of serum alanine transaminase, aspartate transaminase, total and direct bilirubin, protein, albumin, calcium, phosphorus, alkaline phosphatase, cholesterol, and triglyceride at the third postnatal week were recorded and compared between the groups. Results are presented as n (%) and median (interquartile range) where appropriate.

Results: 76 preterm neonates (SMOFlipid group: n=37 and ClinOleic group: n=39) were included. The gestational age [weeks; SMOFlipid group: 28 (27–30), ClinOleic group: 28 (27–29); p=0.477] and birth weight [gram; SMOFlipid group: 1080 (840–1290), ClinOleic group: 850 (1000–1230); p:0.454] were similar in the groups. The duration of parenteral nutrition was comparable [days; SMOFlipid group: 11 (10–14), ClinOleicgroup: 12 (10–19); p=0.217]. The serum alanine transaminase [U/L; SMOFlipid group: 9 (7–11), ClinOleic group: 10 (7–12); p=0.742] and aspartate transaminase [U/L; SMOFlipid group: 24 (18–28), ClinOleic group: 25 (20–31); p=0.365] as well as other biochemical tests were similar between two groups. Cholestasis occurred in four infants [ClinOleic group: 3 (8%), SMOFlipid group: 1 (3%), p=0.330].

Conclusion: It was demonstrated that liver function tests and levels of cholesterol and triglyceride were not affected in infants who had received parenteral lipid emulsions based on fish oil or olive oil

Keywords: Intravenous fat emulsion, Liver Function Tests, Omega-3 fatty acids, Parenteral nutrition, Premature infants

References

  1. 1. Satrom K, Gourley G. Cholestasis in preterm Infants. Clin Perinatol
  2. 2016;43:355-73.
  3. 2. Beale EF, Nelson RM, Bucciarelli RL, Donnelly WH, Eitzman DV.
  4. Intrahepatic cholestasis associated with parenteral nutrition in
  5. premature infants. Pediatrics 1979;64:342-7
  6. 3. Christensen RD, Henry E, Wiedmeier SE, Burnett J, Lambert
  7. DK. Identifying patients, on the first day of life, at high-risk of
  8. developing parenteral nutrition-associated liver disease. J Perinatol
  9. 2007;27:284-90.
  10. 4. Xu ZW, Li YS. Pathogenesis and treatment of parenteral
  11. nutrition-associated liver disease. Hepatobiliary Pancreat Dis Int
  12. 2012;11:586-93.
  13. 5. Kim AY, Lim RK, Han YM, Park KH, Byun SY. Parenteral nutritionassociated cholestasis in very low birth weight infants: A single
  14. center experience. Pediatr Gastroenterol Hepatol Nutr 2016;19:61-
  15. 70.
  16. 6. Deshpande G, Simmer K, Deshmukh M, Mori TA, Croft KD,
  17. Kristensen J. Fish Oil (SMOFlipid) and olive oil lipid (Clinoleic) in very
  18. preterm neonates. J Pediatr Gastroenterol Nutr 2014;58:177-82.
  19. 7. Deshpande GC, Simmer K, Mori T, Croft K. Parenteral lipid
  20. emulsions based on olive oil compared with soybean oil in preterm
  21. (<28 weeks’ gestation) neonates: A randomised controlled trial. J
  22. Pediatr Gastroenterol Nutr 2009;49:619-25.
  23. 8. Vlaardingerbroek H, Vermeulen MJ, Carnielli VP, Vaz FM, van den
  24. Akker CH, van Goudoever JB. Growth and fatty acid profiles of
  25. VLBW infants receiving a multicomponent lipid emulsion from birth.
  26. J Pediatr Gastroenterol Nutr 2014;58:417-27.
  27. 9. Weinberger B, Watorek K, Strauss R, Witz G, Hiatt M, Hegyi T.
  28. Association of lipid peroxidation with hepatocellular injury in
  29. preterm infants. Crit Care 2002;6:521-5.
  30. 10. Köşger P, Özer E, Helvacı M. Preterm bebeklerde total parenteral
  31. beslenme ile ilişkili komplikasyonların sıklığı ve risk faktörleri. J
  32. Pediatr Res 2016;3:149-53.
  33. 11. Tomsits E, Pataki M, Tolgyesi A, Fekete G, Rischak K, Szollar L.
  34. Safety and efficacy of a lipid emulsion containing a mixture of
  35. soybean oil, medium-chain triglycerides, olive oil, and fish oil: A
  36. randomised, double-blind clinical trial in premature infants requiring
  37. parenteral nutrition. J Pediatr Gastroenterol Nutr 2010;51:514-21.
  38. 12. D’Ascenzo R, Savini S, Biagetti C, Bellagamba MP, Marchionni P,
  39. Pompilio A, et al. Higher docosahexaenoic acid, lower arachidonic
  40. acid and reduced lipid tolerance with high doses of a lipid emulsion
  41. containing 15% fish oil: A randomized clinical trial. Clin Nutr
  42. 2014;33:1002-9.
  43. 13. Krawinkel MB. Parenteral nutrition-associated cholestasis-what do
  44. we know, what can we do? Eur J Pediatr Surg 2004;14:230-4.
  45. 14. Albers MJ, de Gast-Bakker DA, van Dam NA, Madern GC,
  46. Tibboel D. Male sex predisposes the newborn surgical patient to
  47. parenteral nutrition-associated cholestasis and to sepsis. Arch
  48. Surg 2002;137:789-93.
  49. 15. Unal S, Demirel N, Erol S, Isik DU, Kulali F, Iyigun F, et al. Effects
  50. of two different lipid emulsions on morbidities and oxidant stress
  51. statuses in preterm infants: An observational study. J Matern Fetal
  52. Neonatal Med 2017:1-7.
  53. 16. Rayyan M, Devlieger H, Jochum F, Allegaert K. Short-term use of
  54. parenteral nutrition with a lipid emulsion containing a mixture of
  55. soybean oil, olive oil, medium-chain triglycerides, and fish oil: A
  56. randomized double-blind study in preterm infants. JPEN J Parenter
  57. Enteral Nutr 2012;36:81s-94s.
  58. 17. Goulet O, Antebi H, Wolf C, Talbotec C, Alcindor LG, Corriol O, et
  59. al. A new intravenous fat emulsion containing soybean oil, mediumchain triglycerides, olive oil, and fish oil: A single-center, doubleblind randomized study on efficacy and safety in pediatric patients
  60. receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr
  61. 2010;34:485-95.
  62. 18. Lacaille F, Gupte G, Colomb V, D’Antiga L, Hartman C, Hojsak I,
  63. et al. Intestinal failure-associated liver disease: A position paper of
  64. the ESPGHAN Working Group of Intestinal Failure and Intestinal
  65. Transplantation. J Pediatr Gastroenterol Nutr 2015;60:272-83.
  66. 19. Goulet OJ. Intestinal failure-associated liver disease and the use of
  67. fish oil-based lipid emulsions. World Rev Nutr Diet 2015;112:90-
  68. 114.
  69. 20. Waitzberg DL, Torrinhas RS, Jacintho TM. New parenteral
  70. lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr
  71. 2006;30:351-67.
  72. 21. Park HW, Lee NM, Kim JH, Kim KS, Kim SN. Parenteral fish
  73. oil-containing lipid emulsions may reverse parenteral nutritionassociated cholestasis in neonates: A systematic review and metaanalysis. J Nutr 2015;145:277-83.

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How to cite

1.
Ünal S, Işık DU, Arifoğlu İ, Erol S, Demirel N, Baş AY. Evaluation of Liver Function Tests in Preterm Infants Receiving Parenteral Lipid Emulsions Based on Fish Oil or Olive Oil. Turk J Pediatr Dis [Internet]. 2018 Aug. 1 [cited 2025 May 25];12(2):124-30. Available from: https://turkjpediatrdis.org/article/view/527