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Fish-Oil Fat Emulsion Supplementation May Reduce the Risk of

Severe Retinopathy in VLBW Infants

Author :
Dorota Pawlik, MD, PhD, Ryszard Lauterbach, MD, PhD, and Ewa Turyk, MD
Departements of Neonatology and Opthalmology, Jagiellonian University Medical
College, Krakow, Poland

Copyright 2011 by the American Academy of Pediatrics


Background
Limited
Ability to
synthesize
DHA from
-Linoleic acid

Replace partially a
Source of soybean and olive
DHA : Breast
Milk or DHA
Premature Increase Risk
of DHA
oil emulsion with a
enriched Infants Insufficiency fish-oil emulsion in
formula
a total daily lipid
requirement

Parentral
nutrition do
not contain
DHA
Key words : Retonopathy of Prematurity,
Docosahexaeonic Acid, DHA, n-3 PUFA, Very Low
Birth Weight Infant, Parenteral Nutrition
Hypothesize
Preterm infant who received fish-oil emulsion in amount equal to one-third of their
total daily intravenous lipid intake, administered from 1st day of life, would exhibit
lowered risk od severe retinopathy of prematurity (ROP) and cholestasis compared
with infants who received a conventional soybean and olive oil emulsion
Patients and Methods
EXPERIMENTAL GROUP HISTORICAL GROUP

1. All Infant who weighed < 1250 g 1. All Infant who weighed < 1250 g
2. Delivered before 32 nd weeks of gestation 2. Delivered before 32 nd weeks of gestation
3. Admitted to the NICU of the Medical 3. Admitted to the neonatal department
College of the Jagiellonian University in between October 1, 2007, and March 31,
Cracow, Poland Between April 1 and 2008.
September 30, 2008 4. Historical cohort of 44 infants was
4. 40 of the 63 admitted infants reviewed for comparison, separated from
prospectively followed 68 infants

Infant without major congenital malformation or inborn metabolic errors and symptoms of
congenital infection were enrolled
Patients and Methods
The following data were collected in infants of both groups:
Birth weight
Gestational age
Apgar score
Clinical Risk Index for Babies (CRIB) score,
Gender and
Antenatal steroid administration.
Patients and Methods
Experimental Group Lipid
emulsion that consisted of 50% of
soybean and olive oil emulsion (20%
clinoleic) and 50% of fish-oil
emulsion (10% Omegaven )
Historical Group Lipid emulsion
that consisted 20% of soybean and
olive oil emulsion (20% clinoleic)
Patients and Methods
Administered of lipid emulsion from 1st day of life as a continous
infusion for 24 hours *)

Initial dose
Birth weight < 1000 g : 0.5 g of lipid per kg of body weight
Birth weight > 1000 g : 1.0 g of lipid per kg of body weight
(Increased by 0.5 to 1.0 of lipid per kg body weight every 24 hours)

*)The treatment protocol was


Enteral feeding : infants in both group were fed initally and advance approved by Jagiellonian
at 20 ml breast milk and formula enriched Universitys ethical committee, and
informed written consent was
obtained from parents of all treated
infants
Outcome
Primary Secondary
Outcome Outcome
Development of
Blood Stream
ROP and need of
Infection
photocoagulation

Occurance of
Cholestatis during Treatment of PDA
hospitalization(*)

Lenght of
Hospitaization

(*)Cholestasis was defined as a serum direct bilirubin Occurence of


value of 1.0 mg/dL if the total bilirubin level was 5 IVH(**) and (**)IVH define as USG evidence for
mg/dL or a direct bilirubin value of 20% of the total BPD(***) intraventricular blood
bilirubin if the total bilirubin level was5 mg/dL, found (***)BPD define as an oxygen
in 2 consecutive measurements requirement at 36 weeks corrected
gestational age
Statistical Analyses
X2 test with 2 degrees of freedom statistical significance of differences
Fishers exact probability test Examining variable of low incidence
Unpaired students t Examine difference between demographic and clinical
characteristic
Logistic regression Estimate possible correlation between analyzed factor and
incidence of ROP
Result

Mortality Rate : Experimental Group (25,3%), Historical Group (27,9%)


Result
RoP in Historical Group Increased risk of laser therapy
Gestational Age (OR : 0,27 (95% CI : 0,06-1.02); P=0.047) )
Stage of RoP (OR : 9.86 (95% CI : 0.83-116.7); P= 0.046) )
Experimental Group Smiliar correlation were not found
Conclusion
Fish-oil based fat emulsion administered from the first day of life may be effective
in the prophylaxis of severe retinopathy.
Multicenter studies and assesed blind controlled optimal dose /preferential fish-
oil emulsion.
THANKS FOR ATTENTION