A Clinical Audit of Growth and Clinical Outcome in Very Low Birthweight Babies at the Auckland City Hospital Neonatal Intensive Care Unit Before and After the Introduction of SMOFlipid

Abstract

Introduction: Intestinal failure associated liver disease in very low birthweight (VLBW; birthweight <1,500 g) babies is associated with lipid emulsion use. Multicomponent lipid emulsions may reduce this risk. The aim of this audit was to determine whether a change from a purely soybean oil-based emulsion (Intralipid) to one containing soy, medium-chain triglycerides, olive oil and fish oil (SMOFlipid) would improve growth and clinical outcomes in VLBW babies born at Auckland City Hospital. Method: Consecutively-born VLBW babies were identified from a prospectively-maintained database. Data were collected from electronic clinical records and are presented as mean (SD). Data were available for 105 babies who received Intralipid and 102 babies who received SMOFlipid. Results: Change in Z-scores for weight, length and head circumference between birth and 28 days or discharge did not differ between cohorts. Significantly fewer babies in the SMOFlipid group developed any retinopathy of prematurity (59% vs. 39%, p=0.005) or intraventricular hemorrhage (15% vs. 27%, p=0.03) prior to discharge. Mean total bilirubin levels were similar between cohorts in weeks 1, 2 and 4 after birth, with a significant difference only observed in week 3 (46 (3–203) vs. 42 (1–158) μmol/L, p=0.04). However, repeated measures analyses indicated that both mean (p=0.01), minimum (p=0.03) and maximum (p=0.04) total bilirubin were significantly lower over the first four weeks of life collectively among babies who received SMOFlipid. Conclusion: These data indicate that SMOFlipid may be a favorable alternative to traditional lipid emulsions in neonatal parenteral nutrition regimens. This evidence will be used to inform the guidelines produced by the New Zealand National Intestinal Failure Service.