title: Pretreatment with an intravenous lipid emulsion increases plasma eicosapentanoic acid and downregulates leukotriene b4, procalcitonin, and lymphocyte concentrations after open heart surgery in infants.
abstract: BACKGROUND
  The effect of providing a lipid emulsion containing medium-chain triglyceride (MCT), soybean oil, and fish oil in critically ill infants is not widely studied. This study investigated lipid emulsion effects on plasma phospholipids and immune biomarkers.
  
  
  METHODS
  Thirty-two infants undergoing cardiopulmonary bypass (CPB) and dependent on parenteral nutrition (PN) were randomized to receive either soybean oil (control, n = 16) or a 50:40:10 mixture of MCT, soybean oil, and fish oil (treatment, n = 16). PN was administered for 3 days preoperatively and 10 days postoperatively. Fatty acids, procalcitonin (PCT), leukotriene B4 (LTB4), and lymphocytes were quantified at baseline, before surgery, and days 1, 7 and 10 after surgery.
  
  
  RESULTS
  PCT was significantly lower in the treatment vs control group 1 day postoperatively (P = .01). The treatment group exhibited a lower ω-6 to ω-3 ratio (P = .0001) and a higher ω-3 concentration at all postoperative study periods (P = .001). Treatment resulted in higher (P < .05) plasma phospholipid eicosapentaenoic acid (EPA) on days 7 and 10, while α-linolenic acid, arachidonic acid, and docosahexaenoic acid remained constant. An increase in plasma phospholipid EPA concentration was associated with a decrease in plasma phospholipid LTB4 concentration (P < .05). On postoperative day 10, treatment infants with high Pediatric Risk of Mortality III scores exhibited a 45% lower lymphocyte concentration (P < .05).
  
  
  CONCLUSIONS
  These findings suggest that treating infants undergoing CPB with a lipid emulsion containing ω-3 improves fatty acid status and results in a lower inflammatory response after surgery. Overall, this alternative ω-3-enriched lipid emulsion may benefit clinical outcomes of critically ill infants after cardiac surgery.
authors.affiliation: Nutrition Service, Alberta Health Services, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada bodil.larsen@albertahealthservices.ca.
authors.forename: Bodil M K
authors.initials: BM
authors.lastname: Larsen
authors.affiliation: Alberta Institute for Human Nutrition, University of Alberta, Edmonton, Alberta, Canada Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Field
authors.affiliation: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Amanda Y
authors.initials: AY
authors.lastname: Leong
authors.affiliation: Alberta Institute for Human Nutrition, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Laksiri A
authors.initials: LA
authors.lastname: Goonewardene
authors.affiliation: Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: John E
authors.initials: JE
authors.lastname: Van Aerde
authors.affiliation: Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.affiliation: Alberta Institute for Human Nutrition, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Clandinin
mesh_terms: D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures / Q000451:nursing; D002315:Cardiopulmonary Bypass / Q000451:nursing*; D015118:Eicosapentaenoic Acid / Q000097:blood; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000494:pharmacology*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D007975:Leukotriene B4 / Q000097:blood; D008214:Lymphocytes / Q000187:drug effects*; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D010743:Phospholipids / Q000097:blood*; D011184:Postoperative Period; D057234:Preoperative Period; D011498:Protein Precursors / Q000097:blood; D013024:Soybean Oil / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D005217:Fat Emulsions, Intravenous; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D010743:Phospholipids; D011498:Protein Precursors; D007975:Leukotriene B4; D013024:Soybean Oil; D002116:Calcitonin; D015118:Eicosapentaenoic Acid; D015740:Calcitonin Gene-Related Peptide
keywords: critical care; docosahexaenoic acid; eicosapentaenoic acid; fat emulsion; intravenous; leukotriene; lymphocyte; procalcitonin