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Is SMOF lipid emulsion better than soy-based lipid emulsion for low birth weight preterm neonates?

Journal of Perinatology volume 40, pages 546–547 (2020)Cite this article

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I was intrigued by the manuscript titled “Multi-component lipid emulsion versus soy-based lipid emulsion for very low birth weight preterm neonates: a prepost comparative study” published in the Journal of Perinatology [1]. However the following points merit further discussion:

  1. (1)

    The median age of initiation of enteral feeds was lower in the SMOF-LE group. The reduction in duration to reach full enteral feeds and to regain birth weight, reduced duration of PN (parenteral nutrition) and reduced duration of intravenous lipid emulsion may be due to the early initiation of enteral feeds rather than the due to SMOF-LE use. Furthermore, donor breastmilk has been shown to improve feeding tolerance in premature infants as compared with formula feeds [2]. Increased donor breastmilk supplementation (from 2013 in author’s unit) could have contributed to the reduced duration to reach full enteral feeds and to regain birth weight in the SMOF-LE group. The number of lipid interruptions will also decrease with overall decreasing duration of intravenous lipid administration.

  2. (2)

    What were the reasons for lipid interruptions in the study? If the interruptions were due to hypertriglyceridemia, data on serum triglyceride level/s of the study subjects should be provided for improved comprehension of the readers. What is the author’s unit protocol for managing hypertriglyceridemia?

  3. (3)

    PN induced cholestasis is often diagnosed after 2–4 weeks of being on PN [3]. A median PN duration of 10 days might be too short to evaluate the association of cholestasis with intravenous lipid intake. Comparing onset of cholestasis in infants with longer exposure to PN (e.g., ≥4 weeks) might be more meaningful. Other factors that may have led to a reduction in the risk of development of cholestasis include earlier initiation of feeds, earlier achievement of full enteral feeds and shorter duration of PN and intravenous lipid administration in the SMOF-LE group. Were these variables controlled for during data analysis with respect to development of cholestasis?

  4. (4)

    Lack of enteral feeds and prolonged duration of PN are important risk factors for the development of osteopenia of prematurity [4]. The earlier initiation of enteral feeds, earlier achievement of full enteral feeds, earlier enteral feed fortification (due to a protocol change in 2014 in the author’s unit) and reduced duration of PN may have contributed to the reduction in osteopenia of prematurity seen in the SMOF-LE group. Hence, it remains unclear if the development of osteopenia of prematurity among the study subjects was affected by the type of lipid emulsion used.

  5. (5)

    Finally, although treated ROP was not different, any ROP was reduced in the SMOF-LE group in this study. However due consideration should be given to other known maternal and infant risk factors for development of ROP including but not limited to duration of ventilation and oxygen supplementation, use of erythropoietin and blood transfusions [5]. Were these risk factors similar in both the study groups? If not, how were the differences accounted for during data analysis?

The median age of initiation of enteral feeds was lower in the SMOF-LE group. The reduction in duration to reach full enteral feeds and to regain birth weight, reduced duration of PN (parenteral nutrition) and reduced duration of intravenous lipid emulsion may be due to the early initiation of enteral feeds rather than the due to SMOF-LE use. Furthermore, donor breastmilk has been shown to improve feeding tolerance in premature infants as compared with formula feeds [2]. Increased donor breastmilk supplementation (from 2013 in author’s unit) could have contributed to the reduced duration to reach full enteral feeds and to regain birth weight in the SMOF-LE group. The number of lipid interruptions will also decrease with overall decreasing duration of intravenous lipid administration.

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References

  1. Torgalkar R, Dave S, Shah J, Ostad N, Kotsopoulos K, Unger S, et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates: a pre-post comparative study. J Perinatol. 2019;39:1118–24.

    Article  CAS  Google Scholar 

  2. Lucas A, Gore SM, Cole TJ, Bamford MF, Dossetor JF, Barr I, et al. Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child. 1984;59:722–30.

    Article  CAS  Google Scholar 

  3. Christensen RD, Henry E, Wiedmeier SE, Burnett J, Lambert DK. Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease. J Perinatol. 2007;27:284–90.

    Article  CAS  Google Scholar 

  4. Chen W, Yang C, Chen H, Zhang B. Risk factors analysis and prevention of metabolic bone disease of prematurity. Medicine. 2018;97:e12861.

    Article  Google Scholar 

  5. Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol. 2018;63:618–37.

    Article  Google Scholar 

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  1. Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA

    Kunal Gupta

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Correspondence to Kunal Gupta.

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Gupta, K. Is SMOF lipid emulsion better than soy-based lipid emulsion for low birth weight preterm neonates?. J Perinatol 40, 546–547 (2020). https://doi.org/10.1038/s41372-020-0590-8

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