Objectives: To compare the impact of two types of fat emulsion on clinical outcomes in preterm infants with varying duration of parenteral nutrition (PN).
Methods: Preterm infants meeting the inclusion criteria were randomly assigned to two groups: medium/long-chain triglyceride fat emulsion (referred to as MCT/LCT) group or multi-oil fat emulsion (containing soybean oil, medium-chain triglycerides, olive oil, and fish oil; referred to as SMOF) group. The infants were stratified into groups based on the duration of PN (15-21 days, 22-28 days, and ≥29 days). Clinical characteristics, nutritional status, biochemical indicators, and clinical outcomes were compared between the two groups.
Results: Compared with the MCT/LCT group, the SMOF group had lower peak levels of triglyceride during the hospital stay in preterm infants with PN of 15-21 days, 22-28 days, and ≥29 days, respectively (P<0.05). Logistic regression trend analysis showed that with a longer duration of PN, the risk of parenteral nutrition-associated cholestasis (PNAC) and bronchopulmonary dysplasia (BPD) significantly increased in the MCT/LCT group (P<0.05), while the risk of brain injury did not significantly change (P>0.05). In the SMOF group, the risks of PNAC and BPD did not significantly change with a longer duration of PN (P>0.05), but the risk of brain injury significantly decreased (P=0.006).
Conclusions: Compared to MCT/LCT, SMOF have better lipid tolerance. With a longer duration of PN, SMOF does not increase the risks of PNAC and BPD and had a protective effect against brain injury. This suggests that in preterm infants requiring long-term PN, the use of SMOF is superior to MCT/LCT.
目的: 比较两种脂肪乳剂不同肠外营养时间对早产儿临床结局的影响。方法: 将符合纳入标准的早产儿随机分为两组：中/长链脂肪乳（medium/long-chain triglyceride fat emulsion，简称MCT/LCT）组和多种油脂肪乳［含大豆油、中链甘油三酯、橄榄油、鱼油（soybean oil, medium-chain triglycerides, olive oil, and fish oil），简称SMOF］组。根据肠外营养持续时间（15~21 d、22~28 d、≥29 d）分层分析，比较两组早产儿的临床特征、营养状况、生化指标和临床结局。结果: 与MCT/LCT组相比，SMOF组肠外营养持续时间分别为15~21 d、22~28 d、≥29 d的早产儿住院期间甘油三酯的峰值水平均较低（P<0.05）。logistic回归趋势性分析显示，随着肠外营养时间延长，MCT/LCT组早产儿肠外营养相关性胆汁淤积症（parenteral nutrition-associated cholestasis, PNAC）及支气管肺发育不良（bronchopulmonary dysplasia, BPD）的发生风险均明显增高（P<0.05），脑损伤的发生风险无明显变化（P>0.05）；SMOF组早产儿随着肠外营养时间延长，PNAC及BPD的发生风险均无明显变化（P>0.05），而脑损伤的发生风险明显降低（P=0.006）。结论: 与MCT/LCT相比，SMOF具有较好的脂质耐受性；随着肠外营养持续时间延长，SMOF不增加PNAC、BPD的发生风险，且对脑损伤具有保护作用，表明在需要长期肠外营养的早产儿中使用SMOF优于MCT/LCT。.
Keywords: Fat emulsion; Nutrition; Parenteral nutrition-associated cholestasis; Preterm infant; Randomized controlled trial.