Relationship between the Effects of Different Parenteral Nutrition Durations of Two Intravenous Fat Emulsions on Intravenous Nutrition-related Immune Status and Clinical Outcomes in Premature Infants
Abstract
Premature infants with immature gastrointestinal tracts rely on parenteral nutrition (PN) to meet nutritional and energy requirements for growth. In this study, we compared the nutrition-related immune status of premature infants receiving SMOF emulsions (multiple oil-fat emulsions) versus those receiving MCT/LCT emulsions (medium-/long-chain triglyceride emulsions) at different times during PN, and we analyzed the relationship between immune function and clinical outcomes.
Sixty premature infants from Dongxihu District People’s Hospital, recruited between September 2023 and September 2024, were divided into an observation group and a control group. The observation group received SMOF emulsions, while the control group received MCT/LCT-containing emulsions. We compared immune function, clinical outcomes, and complications between the two groups at different PN timings. The effects of fat-emulsion type on immune indices and their relationship with clinical outcomes were assessed using logistic regression and ROC analysis.
The clinical data of the preterm infants in both groups were similar. Immune function and clinical outcomes were better in the observation group than in the control group, and the complication rate was lower. Logistic and ROC analyses revealed that the type of fat emulsion was closely related to immune indices, and these immune indices were highly correlated with clinical outcomes.
Both interventions improved immunity in preterm infants, with better results in the observation group than in the control group. The use of SMOF emulsions was superior to MCT/LCT-containing emulsions in preterm infants requiring long-term PN, and this immune improvement significantly optimizes clinical outcomes.
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14. Dingess KA, van Dam P, Zhu J, Mank M, Knipping K, Heck AJR, et al. Optimization of a human milk-directed quantitative sIgA ELISA method substantiated by mass spectrometry. Anal Bioanal. 2021;413(20):5037-49.
15. Horna P, Weybright MJ, Ferrari M, Jungherz D, Peng Y, Akbar Z, et al. Dual T-cell constant β chain (TRBC) 1 and TRBC2 staining for the identification of T-cell neoplasms by flow cytometry. Blood Cancer J. 2024;14(1):34.
16. Wang Y, Shen W, Yang Q, Lin R, Tang L, Bai R, et al. Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study. BMC Pediatr. 2023;23(1):250.
17. Schmidt AR, Ramamoorthy C. Bronchopulmonary dysplasia. Pediatr Anesth. 2022;32(2):174-80.
18. Glaser K, Härtel C, Klingenberg C, Herting E, Fortmann MI, Speer CP, et al. Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants. JAMA Netw Open. 2024;7(7):e2423933.
19. Bonafiglia E, Gusson E, Longo R, Ficial B, Tisato MG, Rossignoli S, et al. Early and late onset sepsis and retinopathy of prematurity in a cohort of preterm infants. Sci Rep. 2022;12(1):11675.
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21. Suganuma H, Bonney D, Andersen CC, McPhee AJ, Sullivan TR, Gibson RA, et al. The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks’ gestation: a randomised controlled trial. BMC Pediatr. 2020;20(1):384.
22. Thoene M, Anderson Berry A. Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits. Nutrients. 2021; 13(7):2289.
23. Cuartero Corbalán N, Aranaga FML, Gómez Ramos MJ, Gómez Sánchez MB, Avilés Plaza FV, Núñez Sánchez MA, et al. Comparison of n-3 PUFA-Enriched vs. Olive-Oil-Based Lipid Emulsion on Oxidative Stress and Inflammatory Response in Critically Ill Post-Surgery Adults: Secondary Analysis of a Randomized Controlled Trial. Int J Mol Sci. 2024;25(21):11739.
24. Navaratnarajah N, Girard G, Sant'Anna G, Langlois H, Sant'Anna AM. The impact of a lipid injectable emulsion (SMOF) on conjugated bilirubin levels in children receiving prolonged parenteral nutrition: A large single center experience. Clin Nutr ESPEN. 2022;49:289-94.
25. Lee YY, Tang TK, Chan ES, Phuah ET, Lai OM, Tan CP, et al. Medium chain triglyceride and medium-and long chain triglyceride: metabolism, production, health impacts and its applications – a review. Crit Rev Food. 2022;62(15):4169-85.
26. Bæk O, Rasmussen MB, Gerts T, Aunsholt L, Zachariassen G, Sangild P, et al. Insulin-like growth factor 1 associated with altered immune responses in preterm infants and pigs. Pediatr Res. 2024;95(1):120-8.
27. Xing L, Zhou J, Siqi H, Miaofa Y, Rui Z. Safety of Multi-oil Fat Emulsion in Parenteral Nutrition of Extremely Low Birth Weight Infants. J Chin Pharm Sci.. 2023;58(21):1977-82.
28. Torgalkar R, Dave S, Shah J, Ostad N, Kotsopoulos K, Unger S, et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates: a pre-post comparative study. J Perinatol. 2019;39(8):1118-24.
29. Mathew R. Signaling Pathways Involved in the Development of Bronchopulmonary Dysplasia and Pulmonary Hypertension. Children. 2020; 7(8):100.
30. Kartam M, Embaireeg A, Albalool S, Almesafer A, Hammoud M, Al Hathal M, et al. Late-onset Sepsis in Preterm Neonates is Associated with Higher Risks of Cerebellar Hemorrhage and Lower Motor Scores at Three Years of Age. Oman Medical Journal. 2022;37(2):e368.
31. Zhang B, Xiu W, Wei E, Zhong R, Wei C, Wang Q, et al. Establishing a nomogram for predicting necrotizing enterocolitis in premature infants: A retrospective multicenter cohort study. Digest and Liver Dis. 2025;57(1):231-40.
32. Hellström A, Pivodic A, Gränse L, Lundgren P, Sjöbom U, Nilsson AK, et al. Association of Docosahexaenoic Acid and Arachidonic Acid Serum Levels With Retinopathy of Prematurity in Preterm Infants. JAMA Network Open. 2021;4(10):e2128771.
33. Rong L, Yang Q, yasen W, Wei S, Xinzhu L, siyu S, et al. Comparison of the impact of different fat emulsions on clinical outcomes in preterm infants with varying duration of parenteral nutrition: a randomized controlled multicenter study. Chinese J Contemporary Ped. 2023;25(9):901.
34. Asfour SS, Alshaikh B, AlMahmoud L, Sumaily HH, Alodhaidan NA, Alkhourmi M, et al. SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants. Nutrients. 2022; 14(19):3952.
2. Stout MJ, Chubiz J, Raghuraman N, Zhao P, Tuuli MG, Wang LV, et al. A multidisciplinary Prematurity Research Cohort Study. PLOS ONE. 2022;17(8):e0272155.
3. Gounaris AK, Sokou R, Gounari EA, Panagiotounakou P, Grivea IN. Extrauterine Growth Restriction and Optimal Growth of Very Preterm Neonates: State of the Art. Nutrients. 2023; 15(14):3231.
4. Rizzo V, Capozza M, Panza R, Laforgia N, Baldassarre ME. Macronutrients and Micronutrients in Parenteral Nutrition for Preterm Newborns: A Narrative Review. Nutrients. 2022; 14(7):1530.
5. Joosten K, Vermeulen M. Principles of feeding the preterm infant. Clin Nu ESPEN. 2024;59:320-7.
6. Berlana D. Parenteral Nutrition Overview. Nutrients. 2022; 14(21):4480.
7. Alburaki W, Yusuf K, Dobry J, Sheinfeld R, Alshaikh B. High Early Parenteral Lipid in Very Preterm Infants: A Randomized-Controlled Trial. J Ped. 2021;228:16-23.
8. Sadu Singh BK, Narayanan SS, Khor BH, Sahathevan S, Abdul Gafor AH, Fiaccadori E, et al. Composition and Functionality of Lipid Emulsions in Parenteral Nutrition: Examining Evidence in Clinical Applications. Front Pharmacol. 2020;11:506.
9. Lin R, Yang Q, Wang Y, Shen W, Lin X, Song S, et al. Comparison of the impact of different fat emulsions on clinical outcomes in preterm infants with varying duration of parenteral nutrition: a randomized controlled multicenter study. Chinese J Contemporary Ped. 2023;25(9):901-8.
10. Frazer LC, Martin CR. Parenteral lipid emulsions in the preterm infant: current issues and controversies. Arch Dis Child-Fetal. 2021;106(6):676-81.
11. Zhang Z, Yang Q, Shen W, Song S, Yang D, Song S, et al. Effect of SMOF lipid emulsion on physical growth and extrauterine growth retardation in very preterm infants: Insights from a multicenter retrospective cohort study. Nutrition. 2023;116:112221.
12. Yang Q, Kong J, Bai R, Yu W, Zhang J, Shen W, et al. Effects of mixed oil emulsion on short-term clinical outcomes in premature infants: A prospective, multicenter, randomized controlled trial. Eur J Clin Nutr. 2023;77(8):823-32.
13. Gao L, Shen W, Wu F, Mao J, Liu L, Chang Y, et al. Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China. Nutrition. 2023;107:111912.
14. Dingess KA, van Dam P, Zhu J, Mank M, Knipping K, Heck AJR, et al. Optimization of a human milk-directed quantitative sIgA ELISA method substantiated by mass spectrometry. Anal Bioanal. 2021;413(20):5037-49.
15. Horna P, Weybright MJ, Ferrari M, Jungherz D, Peng Y, Akbar Z, et al. Dual T-cell constant β chain (TRBC) 1 and TRBC2 staining for the identification of T-cell neoplasms by flow cytometry. Blood Cancer J. 2024;14(1):34.
16. Wang Y, Shen W, Yang Q, Lin R, Tang L, Bai R, et al. Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: a multicenter observational study. BMC Pediatr. 2023;23(1):250.
17. Schmidt AR, Ramamoorthy C. Bronchopulmonary dysplasia. Pediatr Anesth. 2022;32(2):174-80.
18. Glaser K, Härtel C, Klingenberg C, Herting E, Fortmann MI, Speer CP, et al. Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants. JAMA Netw Open. 2024;7(7):e2423933.
19. Bonafiglia E, Gusson E, Longo R, Ficial B, Tisato MG, Rossignoli S, et al. Early and late onset sepsis and retinopathy of prematurity in a cohort of preterm infants. Sci Rep. 2022;12(1):11675.
20. Robinson DT, Calkins KL, Chen Y, Cober MP, Falciglia GH, Church DD, et al. Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition. J Parenteral Enteral Nut. 2023;47(7):830-58.
21. Suganuma H, Bonney D, Andersen CC, McPhee AJ, Sullivan TR, Gibson RA, et al. The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks’ gestation: a randomised controlled trial. BMC Pediatr. 2020;20(1):384.
22. Thoene M, Anderson Berry A. Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits. Nutrients. 2021; 13(7):2289.
23. Cuartero Corbalán N, Aranaga FML, Gómez Ramos MJ, Gómez Sánchez MB, Avilés Plaza FV, Núñez Sánchez MA, et al. Comparison of n-3 PUFA-Enriched vs. Olive-Oil-Based Lipid Emulsion on Oxidative Stress and Inflammatory Response in Critically Ill Post-Surgery Adults: Secondary Analysis of a Randomized Controlled Trial. Int J Mol Sci. 2024;25(21):11739.
24. Navaratnarajah N, Girard G, Sant'Anna G, Langlois H, Sant'Anna AM. The impact of a lipid injectable emulsion (SMOF) on conjugated bilirubin levels in children receiving prolonged parenteral nutrition: A large single center experience. Clin Nutr ESPEN. 2022;49:289-94.
25. Lee YY, Tang TK, Chan ES, Phuah ET, Lai OM, Tan CP, et al. Medium chain triglyceride and medium-and long chain triglyceride: metabolism, production, health impacts and its applications – a review. Crit Rev Food. 2022;62(15):4169-85.
26. Bæk O, Rasmussen MB, Gerts T, Aunsholt L, Zachariassen G, Sangild P, et al. Insulin-like growth factor 1 associated with altered immune responses in preterm infants and pigs. Pediatr Res. 2024;95(1):120-8.
27. Xing L, Zhou J, Siqi H, Miaofa Y, Rui Z. Safety of Multi-oil Fat Emulsion in Parenteral Nutrition of Extremely Low Birth Weight Infants. J Chin Pharm Sci.. 2023;58(21):1977-82.
28. Torgalkar R, Dave S, Shah J, Ostad N, Kotsopoulos K, Unger S, et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates: a pre-post comparative study. J Perinatol. 2019;39(8):1118-24.
29. Mathew R. Signaling Pathways Involved in the Development of Bronchopulmonary Dysplasia and Pulmonary Hypertension. Children. 2020; 7(8):100.
30. Kartam M, Embaireeg A, Albalool S, Almesafer A, Hammoud M, Al Hathal M, et al. Late-onset Sepsis in Preterm Neonates is Associated with Higher Risks of Cerebellar Hemorrhage and Lower Motor Scores at Three Years of Age. Oman Medical Journal. 2022;37(2):e368.
31. Zhang B, Xiu W, Wei E, Zhong R, Wei C, Wang Q, et al. Establishing a nomogram for predicting necrotizing enterocolitis in premature infants: A retrospective multicenter cohort study. Digest and Liver Dis. 2025;57(1):231-40.
32. Hellström A, Pivodic A, Gränse L, Lundgren P, Sjöbom U, Nilsson AK, et al. Association of Docosahexaenoic Acid and Arachidonic Acid Serum Levels With Retinopathy of Prematurity in Preterm Infants. JAMA Network Open. 2021;4(10):e2128771.
33. Rong L, Yang Q, yasen W, Wei S, Xinzhu L, siyu S, et al. Comparison of the impact of different fat emulsions on clinical outcomes in preterm infants with varying duration of parenteral nutrition: a randomized controlled multicenter study. Chinese J Contemporary Ped. 2023;25(9):901.
34. Asfour SS, Alshaikh B, AlMahmoud L, Sumaily HH, Alodhaidan NA, Alkhourmi M, et al. SMOFlipid Impact on Growth and Neonatal Morbidities in Very Preterm Infants. Nutrients. 2022; 14(19):3952.
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| Fat emulsion Immunity Outcome assessment Parenteral nutrition Premature | ||
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How to Cite
1.
Yao L, Huang F. Relationship between the Effects of Different Parenteral Nutrition Durations of Two Intravenous Fat Emulsions on Intravenous Nutrition-related Immune Status and Clinical Outcomes in Premature Infants. Iran J Allergy Asthma Immunol. 2025;:1-16.
