Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A double-blind, randomized clinical trial of the effect of ω-3 fatty acids on the oxidative stress of preterm neonates fed through parenteral nutrition

Abstract

Background/Objectives:

The aim of this study was to research and draw conclusions about the effect of a parenteral nutrition (PN) fat emulsion, rich in ω-3 fatty acids, on the antioxidant markers of preterm infants, when compared with a standard fat emulsion. This was a double-blind, parallel-group study conducted in Athens, Greece, using an equal randomization method.

Subjects/Methods:

Thirty-eight infants were selected using a double-blind method and a computer-generated randomization list. Both groups received PN, based on the same protocols. Group A received SMOFlipid fat emulsion, while group B received the standard fat emulsion (Intralipid). Serum levels of vitamin A, E and total antioxidant potential (TAP) were measured on days 0, 7 and 14 of PN support. Clinical and biochemical data were collected on days 0, 14 and on the day of discharge.

Results:

Serum levels of vitamin E and A were significantly increased in group A, while only vitamin A serum level was increased in group B on the fourteenth day (group A: vitamin E: P-value=0.002, vitamin A: P-value=0.000, group B: vitamin E: P-value=0.065, vitamin A: P-value=0.000). TAP was increased only in the intervention group (group A: P-value=0.000, group B: P-value=0.287). Mild anemia was developed in both groups, while no differences were detected in the infection rate, days of hospitalization, days of ventilator support and days of phototherapy.

Conclusions:

Oxidative stress was significantly reduced in those neonates fed with ω-3 fatty acids, whereas no effect was observed in the neonates fed with standard lipids. Intervention had no effect on infants’ growth and clinical outcome.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • ASPEN Board of Directors (1993). Nutrition support for low birth weight infants. J Parenter Enteral Nutr 17, 33SA–38SA.

    Google Scholar 

  • Antebi H, Mansoor O, Ferrier C, Tetegan M, Morvan C, Rangaraj J et al. (2004). Liver function and plasma antioxidant status in intensive care unit patients requiring total parenteral nutrition: comparison of 2 fat emulsions. J Parenter Enteral Nutr 28, 142–148.

    Article  CAS  Google Scholar 

  • Atkinson SA (2001). Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia. J Nutr 131, 942S–946S.

    Article  CAS  Google Scholar 

  • Blackburn S (2005). Free radicals in perinatal and neonatal care, Part 1: the basics. J Perinat Neonatal Nurs 19, 298–300.

    Article  Google Scholar 

  • Buonocore G, Perrone S, Longini M, Vezzosi P, Marzocchi B, Paffetti P et al. (2002). Oxidative stress in preterm neonates at birth and on the seventh day of life. Pediatr Res 52, 46–49.

    Article  CAS  Google Scholar 

  • Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJA (2010). Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med 36, 735–749.

    Article  CAS  Google Scholar 

  • Darlow BA, Graham PJ (2007). Vitamin A supplementation for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev (4). Art. No. CD000501.

  • Debier C (2007). Vitamin E during pre- and postnatal periods. Vitam Horm 76, 357–373.

    Article  CAS  Google Scholar 

  • Gibson RA, Chen W, Makrides M (2001). Randomized trials with polyunsaturated fatty acid interventions in preterm and term infants: functional and clinical outcomes. Lipids 36, 873–883.

    Article  CAS  Google Scholar 

  • Gibsona RA, Chenb W, Makrides M (2001). Randomized trials with polyunsaturated fatty acid interventions in preterm and term infants: functional and clinical outcomes. Lipids 36, 873–883.

    Article  Google Scholar 

  • Gitto E, Pellegrino S, Gitto P, Barberi I, Reiter RJ (2009). Oxidative stress of the newborn in the pre- and postnatal period and the clinical utility of melatonin. J Pineal Res 46, 128–139.

    Article  CAS  Google Scholar 

  • Griffiths HR, Moller L, Bartosz G, Bast A, Bertoni-Freddari C, Collins A et al. (2002). Biomarkers. Mol Aspects Med 23, 101–208.

    Article  CAS  Google Scholar 

  • Mactier H, Weaver LT (2005). Vitamin A and preterm infants: what we know, what we don’t know, and what we need to know. Arch Dis Child Fetal Neonatal Ed 90, 103–108.

    Article  Google Scholar 

  • Maltepe E, Saugstad OD (2009). Oxygen in health and disease: regulation of oxygen homeostasis--clinical implications. Pediatr Res 65, 261–268.

    Article  CAS  Google Scholar 

  • National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition (1997). Safe practices for parenteral nutrition formulations. J Parenter Enteral Nutr 22, 49–66.

    Google Scholar 

  • Orzalesi M (1987). Vitamins and the premature. Biol Neonate 52 (Suppl 1), 97–112.

    Article  CAS  Google Scholar 

  • Perrone S, Salvi G, Bellieni CV, Buonocore G (2007). Oxidative stress and nutrition in the preterm newborn. J Pediatr Gastroenterol Nutr 45, S178–S182.

    Article  CAS  Google Scholar 

  • Petrich C, Voss HV, Lietke K, Gobel U (1976). Vitamin E concentrations in term and preterm newborns and their clinical course. Eur J Pediatr 122, 275–279.

    Article  CAS  Google Scholar 

  • Salsbury DC (2001). Anemia of prematurity. Neonatal Netw 20, 13–20.

    Article  CAS  Google Scholar 

  • Saugstad OD (1996). Mechanism of tissue injury by oxygen radicals: implications for neonatal disease. Acta Pediatr 85, 1–4.

    Article  CAS  Google Scholar 

  • Saugstad OD (2001). Update of oxygen radical disease in neonatology. Curr Opin Obstet Gynecol 13, 147–153.

    Article  CAS  Google Scholar 

  • Sharda B (2006). Free radicals: emerging challenge in environmental health research in childhood and neonatal disorders. Int J Environ Res Public Health 3, 286–291.

    Article  CAS  Google Scholar 

  • Skouroliakou M, Konstantinou D, Papasarantopoulos P, Matthaiou C (2005). Computer assisted total parenteral nutrition for pre-term and sick term neonates. Pharm World Sci 27, 305–310.

    Article  Google Scholar 

  • Thibeault DW (2000). The precarious antioxidant defenses of the preterm infant. Am J Perinat 17, 167–181.

    Article  CAS  Google Scholar 

  • Tyson JE, Wright LL, Oh W, Kennedy KA, Mele L, Ehrenkranz RA et al. (1999). Vitamin A supplementation for extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network. N Engl J Med 340, 1962–1968.

    Article  CAS  Google Scholar 

  • Uauy R, Hoffman DR (2000). Essential fat requirements of preterm infants. Am J Clin Nutr 71, 245S–250S.

    Article  CAS  Google Scholar 

  • Valentine CJ, Puthoff TD (2007). Enhancing parenteral nutrition therapy for neonates. Nutr Clin Pract 22, 183–193.

    Article  Google Scholar 

  • Yeung MY (2006). Influence of early postnatal nutritional management on oxidative stress and antioxidant defense in extreme prematurity. Acta Pediatr 95, 153–163.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Fresenius Kabi for offering the lipid emulsions that were used for the intervention group (SMOFlipid). We also thank Mandy Persidi for editing the final version of the paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M Skouroliakou.

Ethics declarations

Competing interests

Fresenius Kabi offered the lipid emulsion SMOFlipid. The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skouroliakou, M., Konstantinou, D., Koutri, K. et al. A double-blind, randomized clinical trial of the effect of ω-3 fatty acids on the oxidative stress of preterm neonates fed through parenteral nutrition. Eur J Clin Nutr 64, 940–947 (2010). https://doi.org/10.1038/ejcn.2010.98

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2010.98

Keywords

This article is cited by

Search

Quick links