Parenteral lipid emulsions in the preterm infant: current issues and controversies

2021 ◽  
pp. fetalneonatal-2020-319108
Author(s):  
Lauren C Frazer ◽  
Camilia R Martin
Keyword(s):  
Fatty Acid ◽  
Health Risk ◽  
Preterm Infant ◽  
Lipid Emulsion ◽  
Health Benefit ◽  
Lipid Emulsions ◽  
Potential Health ◽  
Oil Emulsion ◽  
Total Fat ◽  
Fatty Acid Deficiency

Parenteral lipid emulsions are a necessary component of nutrition for extremely low gestational age newborns until adequate levels of enteral intake are established. Historically, Intralipid, a 100% soybean oil emulsion, has filled this role. Newer multicomponent lipid emulsions containing a mixture of other oils, including olive oil and fish oil, are now available as options, although the regulatory approval for use in neonates varies worldwide. When dosed at currently published recommendations, each of these lipid emulsions meets total fat and energy requirements without a risk of essential fatty acid deficiency. Thus, when choosing which lipid emulsion to provide, the answer must be based on the metabolic differences induced as a result of these fatty acid-rich emulsions and whether the emulsions provide a health advantage or pose a health risk. The questions of induced fatty acid profiles, health benefit and health risk are discussed sequentially for multicomponent lipid emulsions. Despite the growing acceptance of multicomponent lipid emulsions, there is concern regarding changes in blood fatty acid levels and potential health risk without strong evidence of benefit. There remains no ideal parenteral lipid emulsion option for the preterm infant. Standardising future animal and human studies in lipid delivery with the inclusion of lipid metabolism data will iteratively provide answers to inform the optimal lipid emulsion for the preterm infant.

scholarly journals Parenteral Fish-Oil Containing Lipid Emulsions Limit Initial Lipopolysaccharide-Induced Host Immune Responses in Preterm Pigs

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 205
Author(s):  
William Yakah ◽  
David Ramiro-Cortijo ◽  
Pratibha Singh ◽  
Joanne Brown ◽  
Barbara Stoll ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Fish Oil ◽  
Soybean Oil ◽  
Inflammatory Responses ◽  
Postnatal Period ◽  
Lipid Emulsions ◽  
Omega 3 ◽  
Oil Emulsion ◽  
Mixed Oil ◽  
The Impact

Multicomponent lipid emulsions are available for critical care of preterm infants. We sought to determine the impact of different lipid emulsions on early priming of the host and its response to an acute stimulus. Pigs delivered 7d preterm (n = 59) were randomized to receive different lipid emulsions for 11 days: 100% soybean oil (SO), mixed oil emulsion (SO, medium chain olive oil and fish oil) including 15% fish oil (MO15), or 100% fish oil (FO100). On day 11, pigs received an 8-h continuous intravenous infusion of either lipopolysaccharide (LPS—lyophilized Escherichia coli) or saline. Plasma was collected for fatty acid, oxylipin, metabolomic, and cytokine analyses. At day 11, plasma omega-3 fatty acid levels in the FO100 groups showed the highest increase in eicosapentaenoic acid, EPA (0.1 ± 0.0 to 9.7 ± 1.9, p < 0.001), docosahexaenoic acid, DHA (day 0 = 2.5 ± 0.7 to 13.6 ± 2.9, p < 0.001), EPA and DHA-derived oxylipins, and sphingomyelin metabolites. In the SO group, levels of cytokine IL1β increased at the first hour of LPS infusion (296.6 ± 308 pg/mL) but was undetectable in MO15, FO100, or in the animals receiving saline instead of LPS. Pigs in the SO group showed a significant increase in arachidonic acid (AA)-derived prostaglandins and thromboxanes in the first hour (p < 0.05). No significant changes in oxylipins were observed with either fish-oil containing group during LPS infusion. Host priming with soybean oil in the early postnatal period preserves a higher AA:DHA ratio and the ability to acutely respond to an external stimulus. In contrast, fish-oil containing lipid emulsions increase DHA, exacerbate a deficit in AA, and limit the initial LPS-induced inflammatory responses in preterm pigs.

scholarly journals A Clinical Evaluation of Safflower Oil Emulsion in Total Parenteral Nutrition

1982 ◽  
Vol 10 (3) ◽  
pp. 258-264 ◽  
Author(s):  
D. G. Tabrett ◽  
G. D. Phillips
Keyword(s):  
Fatty Acid ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Essential Fatty Acid ◽  
Essential Fatty Acid Deficiency ◽  
Serum Triglyceride ◽  
Safflower Oil ◽  
Oil Emulsion ◽  
Acid Deficiency ◽  
Fatty Acid Deficiency

A new intravenous safflower oil emulsion (Liposyn, Abbott) was administered to 23 patients receiving total parenteral nutrition. In a prospective clinical trial, 500 ml of the 10% emulsion was administered each day for a minimum of 10 days. Plasma fatty acid estimations showed a rise in linoleic acid in 22 patients, and a fall in triene/tetraene ratio (a guide to the presence of essential fatty acid deficiency), in 17 patients within four days of commencement of the infusion. Administration of Liposyn prevented the development of biochemical evidence of essential fatty acid deficiency. There were no clinical side effects attributable to the emulsion. Elevation of serum triglyceride and liver enzyme concentrations occurred in some patients.

scholarly journals Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols

2005 ◽  
Vol 94 (2) ◽  
pp. 221-230 ◽  
Author(s):  
A. García-de-Lorenzo ◽  
R. Denia ◽  
P. Atlan ◽  
S. Martinez-Ratero ◽  
A. Le Brun ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Fatty Acid ◽  
Linoleic Acid ◽  
Liver Function ◽  
Parenteral Nutrition ◽  
Lipid Emulsion ◽  
Liver Function Tests ◽  
Lipid Emulsions ◽  
Double Blind ◽  
Long Chain

It has been claimed that lipid emulsions with a restricted linoleic acid content can improve the safety of total parenteral nutrition (TPN). The tolerability of TPN and its effects on the metabolism of fatty acids were assessed in this prospective, double-blind, randomised study comparing an olive/soyabean oil long-chain triacylglycerol (LCT) with a medium-chain triacylglycerol (MCT)/LCT; 50:50 (w) based lipid emulsion in two groups (O and M, respectively; eleven per group) of severely burned patients. After resuscitation (48–72 h), patients received TPN providing 147 kJ/kg per d (35 kcal/kg per d) with fat (1·3 g/kg per d) for 6 d Plasma fatty acids, laboratory parameters including liver function tests, and plasma cytokines were assessed before and after TPN. Adverse events encountered during TPN and the clinical outcomes of patients within the subsequent 6 months were recorded. With both lipid emulsions, the conversion of linoleic acid in its higher derivatives (di-homo-γ-linolenic acid) improved and essential fatty acid deficiency did not appear. Abnormalities of liver function tests occurred more frequently in the M (nine) than in the O (three) group (P=0·04, Suissa–Shuster test). Seven patients (four from group O and three from group M) died as a consequence of severe sepsis 3–37 d after completion of the 6 d TPN period. When compared with the surviving patients, those who died were older (P=0·01) and hyperglycaemic at baseline (P<0·001), and their plasma IL-6 levels continued to increase (P<0·04). Although fatty acid metabolism and TPN tolerability were similar with both lipid emulsions, the preservation of liver function noted with the use of the olive oil-based lipid emulsions deserves confirmation.

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