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Am J Perinatol 2019; 36(13): 1382-1386
DOI: 10.1055/s-0038-1676977
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

SMOFlipid Protects Preterm Neonates against Perinatal Nutrition–Associated Cholestasis

Yair Kasirer   *
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Alona Bin-Nun   *
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2   Department of Pediatrics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
,
Ateret Raveh
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Irina Schorrs
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
,
Francis B. Mimouni
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
3   Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Cathy Hammerman
1   Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
2   Department of Pediatrics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
› Author Affiliations
Funding None.
Further Information

Publication History

04 October 2018

25 November 2018

Publication Date:
08 January 2019 (online)

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Abstract

Objective Intravenous lipid infusions improve both short- and long-term outcomes of premature neonates. However, prolonged infusion of lipids has been implicated in the development of parenteral nutrition-associated cholestasis (PNAC). We speculated that the multicomponent SMOFlipid would be hepatoprotective against PNAC.

Study Design This is a retrospective review comparing the incidence and severity of direct hyperbilirubinemia in preterm infants <1,500 g who were hospitalized for a minimum of 2 weeks during a 20-month period in which all preterm infants on total parenteral nutrition (TPN) received fat as Lipofundin with the following 20-month period in which all preterm infants on TPN received SMOFlipid.

Results Infants in the SMOFlipid period had a lower incidence of PNAC (6 vs. 13%; p = 0.022), lower peak direct bilirubin levels (3.2 vs. 7.1 mg/dL; p = 0.018), and a shorter length of stay (51 vs. 60 days; p = 0.019). The relative risk of developing direct hyperbilirubinemia during the Lipofundin period was 2.22 (1.1–4.3) as compared with period 1; p = 0.018; NNT-14.

Conclusion SMOFlipid was hepatoprotective in our population of preterm neonates <1,500 g receiving long-term TPN as compared with those receiving Lipofundin, despite similar levels of exposure to both intravenous lipid load and duration in the two groups.

Keywords

perinatal nutrition - cholestasis - long chain polyunsaturated fatty acids

* Contributed equally as first authors.