Parenteral soybean oil lipid emulsion in very low birth weight (vlbw) in intensive care

Abstract

Preterm infants, especially very low birth weight (VLBW) infants, often require parenteral lipid emulsion (LE) if adequate energy and lipid intake cannot be achieved by enteral feeding. This is because their polyunsaturated fatty acid (PUFA) body stores are very low, whereas their metabolic requirements are high. The conventional LE for preterm infants is mostly soybean oil. However, the adequacy of soybean LE has been questioned, primarily in view of the very high concentrations of linoleic acid (LA, 18:2n-6) relative to α-linolenic acid (ALA, 18:3n-3) and because of the absence of arachidonic acid (ARA, 20:4n-6) and docosahexaenoic acid (DHA, 22:6n-3). The large amounts of LA in soybean LE may further impair PUFA formation via substrate inhibition. A randomized controlled trial concluded that VLBW infants can tolerate 2 g/kg/day of soybean LE during the first few days of life without significant adverse events. A recent meta-analysis in preterm infants showed that parenteral LE within the first 2 days of life seems safe and well tolerated. However, larger studies are needed to confirm the effect of early LE or the results from LE in terms of growth, respiratory morbidity, and neurodevelopment for VLBW infants’ short- and long-term outcomes.