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Growth and Fatty Acid Profiles of VLBW Infants Receiving a Multicomponent Lipid Emulsion From Birth

Vlaardingerbroek, Hester*; Vermeulen, Marijn J.*; Carnielli, Virgilio P.; Vaz, Frédéric M.; van den Akker, Chris H.P.*; van Goudoever, Johannes B.§

Journal of Pediatric Gastroenterology and Nutrition: April 2014 - Volume 58 - Issue 4 - p 417–427
doi: 10.1097/MPG.0000000000000280
Original Articles: Hepatology and Nutrition

Objectives: Very-low-birth-weight (VLBW) infants are dependent on parenteral nutrition after birth. A parenteral lipid emulsion with a multicomponent composition may improve growth and neurodevelopment and may prevent liver injury, which is often observed in association with long-term parenteral nutrition with pure soybean oil. Our aim was to evaluate the safety and efficacy of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triacylglycerol, 25% olive oil, and 15% fish oil compared with a conventional pure soybean oil emulsion in VLBW infants.

Methods: We conducted a double-blind randomized controlled trial in VLBW infants randomized to parenteral nutrition with the multicomponent (study group) or pure soybean oil emulsion (control group) from birth at a dose of 2 to 3 g · kg−1 · day−1 until the infants were receiving full enteral nutrition. We assessed efficacy by growth rates and measuring plasma fatty acid profiles (representative subset). Safety was evaluated by assessing hematologic and biochemical parameters, potentially harmful phytosterol concentrations (same subset), and clinical neonatal outcome parameters.

Results: Ninety-six infants were included (subsets n = 21). The multicomponent emulsion was associated with higher weight and head circumference z scores during admission. Plasma eicosapentaenoic acid and docosahexaenoic acid concentrations were higher in the study group. The hematological, biochemical, and neonatal outcomes were not different between groups, whereas the plasma concentrations of phytosterols were higher in the control group.

Conclusions: The multicomponent lipid emulsion was well tolerated and associated with improved growth and higher plasma fatty acid profiles in VLBW infants in comparison with the pure soybean oil emulsion.

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*Department of Pediatrics, Division of Neonatology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands

Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy

Department of Clinical Chemistry and Pediatrics

§Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Johannes B. van Goudoever, Emma Children's Hospital, AMC, c/o Room H7-282, PO Box 22660, 1100 DD Amsterdam, The Netherlands (e-mail:

Received 11 December, 2013

Accepted 11 December, 2013

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

The study described in this article is part of a larger trial that has been registered at trial registration no.: NTR1445.

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,