SMOFLipid vs Clinoleic - randomised controlled trial

Survival of high-risk premature babies has improved significantly in the last 20 years. Feeding intolerance is a common issue seen in extremely preterm babies, and in those with conditions such as gastroschrisis, definite necrotising enterocolitis, and short bowel syndrome. Long-term support with parenteral nutrition (PN) is crucial for these babies to provide optimal nutrition at a critical stage of development. Lipid formulations are an important component of PN, being a good source of energy, essential fatty acids (EFA), and also of long chain polyunsaturated fatty acids (LC-PUFAs). In recent years, focus on omega-3 fatty acids has stipulated that increased omega-3 LCPUFA, mainly docosahexanoic acid (DHA), supplementation may have extra beneficial effects for extremely premature babies who have higher rates and severity of neonatal diseases of prematurity, such as late onset sepsis, necrotising enterocolitis, respiratory diseases of the newborn, and as such have a higher inflammatory status. A recent study by Deshpande et al. (2014) examined the use of SMOFLipid, a lipid emulsion with higher omega-3 content, compared to ClinOleic, a lipid emulsion with low omega-3 content, and found that eicosapentanoic acid (EPA) levels, and F2-isoprostane (an inflammatory marker) were slightly decreased. However docosahexanoic acid (DHA) levels were found to be similar. Soybean lipid emulsions are associated with parenteral nutrition-associated cholestasis and liver disease and studies with using pure fish oil based emulsion showed improvement in the cholestasis. The effect on phytosterol levels by lipid emulsions has not previously been studied in extremely premature neonates. This randomised controlled trial will compare the fatty acid levels, phytosterol levels, liver function tests and conjugated bilirubin in both groups. We hypothesis that in very preterm neonates born before 29 weeks, fish oil based lipid emulsion will result in higher omega-3 fatty acids levels as compared to standard olive oil based lipid emulsion.