The efficacy of fish-oil based fat emulsion administered from the first day of life in very low birth weight newborns.

BACKGROUND: DHA has been shown to be important for foetal brain development, optimal development for motor skills and visual acuity in infants. Newborns born prematurely are at increased risk for DHA (docosahexaenoic acid) insufficiency because they may not have benefited from a full trimester of the mother's lipid stores and have very limited ability to synthesize DHA. Moreover, within the first 2-3 weeks of life, the main sources of lipids for most prematurely delivered infants are soyabean/safflower/olive oil emulsions which are rich in n-6 fatty acids and do not contain DHA.

AIM: To perform a retrospective analysis, which compares the safety and efficacy outcomes of an intravenous fat emulsion based on fish-oil (containing docosahexaenoic acid- DHA), and is administered from the first day of life in very low birth weight newborns, with data obtained in preterm neonates with birthweight below 1500 g, receiving soyabean/olive oil emulsion, which do not contain DHA.

MATERIALS AND METHODS: Infants from the two groups (the study group n=152; the control group n=185) were comparable with regard to demographic and clinical characteristics and were subjected to the same conventional therapy. Determination of plasma and erythrocytes DHA concentrations in newborns was made using a high-performance liquid chromatography-mass spectrometry (LC-ESI/MS) method. Detection of parent ions with negative ionization mode, m/z 327.5 amu. Method validation was according to the ICH and FDA requirements.

RESULTS: There was a significantly lower risk of cholestasis in infants, who were receiving the soyabean/ olive oil/fish-oil emulsion (p=0.025). Also, there was a markedly lower risk of laser therapy in infants, who were receiving a fish-oil emulsion however, the difference did not reach statistical significance.

CONCLUSIONS: Fish-oil-based fat emulsion administered as a component of total parenteral nutrition from the first day of life is safe in the prophylaxis of cholestasis and severe retinopathy of prematurity. Further clinical investigations are needed.