A Mixed Lipid Emulsion Containing Fish Oil and Its Effect on Electrophysiological Brain Maturation in Infants of Extremely Low Birth Weight: A Secondary Analysis of a Randomized Clinical Trial

Abstract

Objective: To assess whether parenteral nutrition for infants of extremely low birth weight using a mixed lipid emulsion that contains fish oil influences electrophysiological brain maturation.

Study design: The study is a prespecified secondary outcome analysis of a randomized controlled trial of 230 infants of extremely low birth weight receiving a mixed (soybean oil, medium-chain triglycerides, olive oil, and fish oil; intervention) or a soybean oil-based lipid emulsion (control). The study was conducted at a single-level IV neonatal care unit (Medical University Vienna; June 2012 to October 2015). Electrophysiological brain maturation (background activity, sleep-wake cycling, and brain maturational scores) was assessed biweekly by amplitude-integrated electroencephalography (birth to discharge).

Results: A total of 317 amplitude-integrated electroencephalography measurements (intervention: n = 165; control: n = 152) from 121 (intervention: n = 63; control: n = 58) of 230 infants of the core study were available for analysis. Demographic characteristics were not significantly different. By 28 weeks of postmenstrual age, infants receiving the intervention displayed significantly greater percentages of continuous background activity. Total maturational scores and individual scores for continuity, cycling, and bandwidth were significantly greater. Maximum maturational scores were reached 2 weeks earlier in the intervention group (36.4 weeks, 35.4-37.5) compared with the control group (38.4 weeks, 37.1-42.4) (median, IQR; P < .001).

Conclusions: Using a mixed parenteral lipid emulsion that contains fish oil, we found that electrophysiological brain maturation was accelerated in infants who were preterm.

Trial registration: ClinicalTrials.gov: NCT01585935.

Keywords: docosahexaenoic acid; electroencephalography; parenteral nutrition; premature infant.

Conflict of interest statement

Conflict of Interest: Andreas Repa received a research grant by Fresenius Kabi (Graz, Austria). The company had no role in the study, in particular concerning the design, analysis, interpretation or reporting of results and preparation of the manuscript. Andreas Repa has a perceived conflict of interest. The other authors have no conflicts of interest to disclose or any financial relationships relevant to the study.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure 1

Total maturational scores of participants plotted with trajectories. Panel A shows that infants in group SMOF-LE (black lines) dominate the highest scores for most postmenstrual ages. Panel B shows that infants in group S-LE (black lines) dominate the lowest scores for most postmenstrual ages. SMOF-LE (lipid emulsion based on a mixture of soybean oil, medium-chain triglycerides, olive oil and fish oil); S-LE (soybean oil-based lipid emulsion).