M Thanhaeuser et al. J Pediatr 2023; 254: 68-74. Open Access: A secondary Outcome Analysis of a Randomized Trial Using a Mixed Lipid Emulsion Containing Fish Oil in Infants with Extremely Low Birth Weight: Cognitive and Behavioral Outcome at Preschool Age

Methods: This was a retrospective secondary outcome analysis of a randomized controlled trial performed between June 2012 and June 2015. Infants with extremely low birth weight received either a mixed (soybean oil, medium chain triglycerides, olive oil, fish oil) or a soybean oil-based lipid emulsion for parenteral nutrition (up to 3 gm/kd/day). At 5 years 6 months of age, data of 153 of 206 infants (74%) were available for analysis.

Key findings:

• At 5 years and 6 months, there were no significant differences in neurocognitive testing from from the Kaufman Assessment Battery for Children II, and the Child Behavior Checklist 1.5-5 and no differences in growth

My take: The discussion highlights the lack of a positive benefit from the mixed emulsion. However, one of the biggest concerns with lipid emulsions occurs in the setting of lipid emulsion restriction due to parenteral nutrition associated liver disease. Because mixed emulsions are better tolerated, this helps minimize lipid restriction which could result in worsened neurocognitive outcomes.

Related blog posts:

• Does SMOFlipid Improve Neurocognitive Outcomes?
• Neurocognitive Function with Pediatric Intestinal Failure
• Parenteral Nutrition: “The Scar Remains”
• SMOF Neurodevelopmental Data Looks Good –In Five Years We’ll Know More (2019)
• #NASPGHAN19 Intestinal Failure Session Part 1