Association between mixed fatty acid emulsion and parenteral nutrition-associated cholestasis in extremely low-birth-weight infants: A retrospective cohort study.

BACKGROUND

Soybean oil lipid emulsions have been implicated in the development of parenteral nutrition-associated cholestasis (PNAC) in premature infants. A recent mixed fatty acid emulsion containing soybean oil, medium-chain triglycerides (MCTs), olive oil, and fish oil may reduce the incidence of PNAC, but evidence remains conflicting. The aim of this study was to evaluate the effect of mixed fatty acid emulsion on PNAC in extremely low-birth-weight (ELBW) infants.

METHODS

We performed a retrospective cohort study on ELBW infants from 2016 to 2022. ELBW infants who received MCT/long-chain triglyceride (LCT) lipid emulsion or mixed fatty acid emulsion were compared. The primary outcome was the incidence of PNAC. Secondary outcomes included peak levels of direct bilirubin and bronchopulmonary dysplasia. Multivariable analysis was performed to adjust for potential confounders.

RESULTS

A total of 180 ELBW infants were reviewed in this study. Twenty-six of 99 patients (26.2%) in the mixed fatty acid emulsion group and 29 of 81 patients (35.8%) in the MCT/LCT lipid emulsion group developed PNAC (P = 0.17). There was no significant difference in median peak direct bilirubin and the rate of bronchopulmonary dysplasia. The results remained consistent after adjusting for potential confounders. Time to PNAC, rate of rise of direct bilirubin, and age of direct bilirubin normalization were not statistically different between groups.

CONCLUSIONS

Compared with MCT/LCT lipid emulsion, mixed fatty acid emulsion did not reduce the incidence or degree of PNAC in ELBW infants.