Parenteral lipid emulsions based on olive oil compared with soybean oil in preterm (<28 weeks' gestation) neonates: a randomised controlled trial.
BACKGROUND
: New olive oil-based (OL) lipid emulsions (olive:soy oil = 4:1) have lower polyunsaturated fatty acid (PUFA) (20% vs 60%) and higher vitamin E content (an antioxidant) compared with traditional soybean oil (SO) emulsions.


OBJECTIVE
: Compare efficacy and safety of OL with SO emulsions in preterm neonates (<28 weeks) at high risk for oxidative stress.


METHODS
: Preterm neonates (gestation 23-<28 weeks) were randomised to receive OL or SO emulsion for 5 days using a standard protocol in a tertiary perinatal centre (King Edward Memorial Hospital for Women, Perth, Western Australia). Investigators and outcome assessors were masked to allocation. Plasma F2-isoprostanes (lipid peroxidation marker), plasma, and red blood cell fatty acids were measured before and after the study. Safety was monitored by liver function tests.


RESULTS
: Forty-four of 50 participants (OL-23, SO-21) completed the study. Both emulsions were well tolerated with no significant adverse events. F2-isoprostane levels were comparable at baseline and study end. Oleic and linoleic acid levels were significantly high on day 6 in OL and SO groups, respectively. Long-chain PUFA levels were similar between groups despite the lower PUFA content of OL. The olive oil-based group had significantly higher levels of C18:4n-3, suggesting Delta6-desaturase enzyme inhibition in the SO group.


CONCLUSIONS
: Olive oil-based emulsion was safe and well tolerated by preterm neonates. Similar long-chain PUFA levels were achieved in the OL group despite significantly lower amount of PUFA content; however, there was no difference in lipid peroxidation (F2-isoprostane levels). Large trials are needed to confirm these benefits.
Deshpande
Girish C
GC
Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia. girish.deshpande@health.wa.gov.au
Simmer
Karen
K
Mori
Trevor
T
Croft
Kevin
K
D001315:Australia; D004311:Double-Blind Method; D028441:F2-Isoprostanes / Q000097:blood; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D005227:Fatty Acids / Q000008:administration & dosage* / Q000097:blood*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena / Q000187:drug effects*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007263:Infusions, Parenteral; D019787:Linoleic Acid / Q000097:blood; D050602:Linoleoyl-CoA Desaturase / Q000037:antagonists & inhibitors; D015227:Lipid Peroxidation / Q000187:drug effects; D019301:Oleic Acid / Q000097:blood; D000069463:Olive Oil; D010938:Plant Oils / Q000008:administration & dosage / Q000494:pharmacology*; D013024:Soybean Oil / Q000008:administration & dosage / Q000494:pharmacology*
D028441:F2-Isoprostanes; D005217:Fat Emulsions, Intravenous; D005227:Fatty Acids; D015525:Fatty Acids, Omega-3; D000069463:Olive Oil; D010938:Plant Oils; D019301:Oleic Acid; D013024:Soybean Oil; D019787:Linoleic Acid; D050602:Linoleoyl-CoA Desaturase