Cochrane · systematic review · CD013163
Lipid emulsions for parenterally fed preterm infants
Kapoor, V, Malviya, MN, Soll, R · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
NeonatalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
44
current version
GRADE rated
39
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 5 · 11.4%Very low 12 · 27.3%Low 27 · 61.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Fish oil lipid emulsion (LE) compared to non‐fish oil LE for parenterally fed preterm infants
Population: parenterally fed preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Growth rate – MOFS‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 5 studies · 347 participants | Low Downgraded: imprecision |
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – all fish oil LE vs non‐fish oil LE (combined subgroups) Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.61 [0.24, 1.56] | 4 studies · 328 participants | Low Downgraded: imprecision |
PNALD/cholestasis (any definition: low and unclear risk of bias studies) – all fish oil LE vs non‐fish oil LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.8 [0.53, 1.21] | 10 studies · 1024 participants | Low Downgraded: imprecision |
PNALD/cholestasis (any definition): combined subgroups (all studies) – all fish oil LE vs non‐fish oil LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.63 [0.43, 0.91] | 11 studies · 1154 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Death before discharge – MOFS‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1.24 [0.81, 1.9] | 9 studies · 855 participants | Low Downgraded: imprecision |
ROP ≥ stage 3 or requiring surgery – all fish oil LE vs non‐fish oil LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.8 [0.55, 1.16] | 7 studies · 731 participants | Very low Downgraded: risk of bias, imprecision |
CLD (oxygen requirement at 36 weeks' postmenstrual age) – MOFS‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1 [0.75, 1.34] | 6 studies · 581 participants | Low Downgraded: imprecision |
Culture‐positive sepsis – fish oil LE vs non‐fish oil LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1.16 [0.91, 1.48] | 7 studies · 774 participants | Low Downgraded: imprecision |
Conjugated bilirubin levels – MOFS‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 8 studies · 673 participants | Low |
Fish oil lipid emulsion (LE) compared to another fish oil LE for parenterally fed preterm infants
Population: parenterally fed preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Growth rate – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | no estimate extracted | 1 study · 55 participants | Low Downgraded: imprecision |
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | RR 0.96 [0.06, 14.65] | 1 study · 55 participants | Low Downgraded: imprecision |
Death before discharge – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | RR 1 [0.15, 6.64] | 1 study · 60 participants | Low Downgraded: imprecision |
CLD (oxygen requirement at 36 weeks' postmenstrual age) – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | RR 1.16 [0.4, 3.35] | 1 study · 55 participants | Low Downgraded: imprecision |
Any sepsis (clinical or culture positive (or both)) – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | RR 1.69 [0.56, 5.11] | 1 study · 55 participants | Low Downgraded: imprecision |
Conjugated bilirubin levels – MOFS‐LE vs MFS‐LE Fish oil lipid emulsion (LE) vs another fish oil LE | no estimate extracted | 1 study · 55 participants | Low Downgraded: imprecision |
Alternative lipid emulsion (LE) versus soybean oil‐based LE (S‐LE) for parenterally fed preterm infants
Population: parenterally fed preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Growth rate – MS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | no estimate extracted | 1 study · 60 participants | Low Downgraded: imprecision |
Growth rate – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | no estimate extracted | 2 studies · 123 participants | Low Downgraded: imprecision |
PNALD/cholestasis (any definition) – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 1 [0.26, 3.86] | 4 studies · 261 participants | Low Downgraded: imprecision |
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 1 [0.15, 6.82] | 2 studies · 159 participants | Low Downgraded: imprecision |
Death before discharge – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 1 [0.21, 4.82] | 3 studies · 224 participants | Low Downgraded: imprecision |
Death before discharge – MS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | no estimate extracted | 1 study · 60 participants | Ungraded |
Any ROP – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 0.98 [0.67, 1.43] | 3 studies · 142 participants | Very low Downgraded: risk of bias, imprecision |
Any BPD – OS‐LE vs S‐LE (sensitivity analysis) Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 1.01 [0.57, 1.79] | 3 studies · 197 participants | Low Downgraded: imprecision |
Culture‐positive sepsis – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | RR 1.22 [0.54, 2.78] | 2 studies · 164 participants | Low Downgraded: imprecision |
Conjugated bilirubin levels – OS‐LE vs S‐LE Alternative lipid emulsion (LE) vs soybean oil‐based LE (S‐LE) | no estimate extracted | 5 studies · 310 participants | Low Downgraded: imprecision |
Alternative lipid emulsion (LE) compared to another alternative‐LE for parenterally fed preterm infants
Population: parenterally fed preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Growth rate – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | no estimate extracted | 1 study · 59 participants | Low Downgraded: imprecision |
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | RR 2.9 [0.12, 68.5] | 1 study · 59 participants | Low Downgraded: imprecision |
Death before discharge – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | no estimate extracted | 1 study · 60 participants | Ungraded |
CLD (oxygen requirement at 36 weeks' postmenstrual age) – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | RR 0.77 [0.23, 2.6] | 1 study · 59 participants | Low Downgraded: imprecision |
Any sepsis (clinical or culture positive (or both)) – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | RR 1.93 [0.65, 5.73] | 1 study · 59 participants | Low Downgraded: imprecision |
Conjugated bilirubin levels – MS‐LE vs OS‐LE Alternative lipid emulsion (LE) vs another alternative‐LE | no estimate extracted | 1 study · 59 participants | Low Downgraded: imprecision |
Fish oil lipid emulsion (LE) compared to non‐fish oil LE in parenterally fed preterm infants with surgical conditions
Population: parenterally fed preterm infants with surgical conditions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1.11 [0.08, 15.28] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Death before discharge – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 19 participants | Ungraded |
Culture‐positive sepsis – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1.11 [0.39, 3.19] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Conjugated bilirubin levels – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Neurodevelopmental outcomes (6 months) – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 11 participants | Ungraded |
Neurodevelopmental outcomes (24 months) – pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 10 participants | Ungraded |
Fish oil lipid emulsion (LE) compared to non‐fish oil LE for parenterally fed preterm infants with cholestasis
Population: parenterally fed preterm infants with cholestasis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Resolution of PNALD/ cholestasis (conjugated bilirubin < 2 mg/dL) Pure F‐LE vs Intralipid Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 5.6 [0.34, 93.35] | 1 study · 16 participants | Very low Downgraded: imprecision |
PNALD/ cholestasis (any definition) MOFS‐LE vs S‐LE Pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.54 [0.32, 0.91] | 2 studies · 40 participants | Very low Downgraded: imprecision |
Growth rate Pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 16 participants | Very low Downgraded: imprecision |
Head growth velocity Pure F‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 16 participants | Very low Downgraded: imprecision |
Death before discharge – MOFS‐LE vs S‐LE – Pure F‐LE vs IL Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 0.24 [0.03, 1.87] | 2 studies · 40 participants | Very low Downgraded: imprecision |
Any sepsis – MOFS‐LE vs S‐LE – Pure F‐LE vs IL Fish oil lipid emulsion (LE) vs non‐fish oil LE | RR 1.21 [0.5, 2.92] | 2 studies · 40 participants | Very low Downgraded: imprecision |
Conjugated bilirubin levels – MOFS‐LE vs S‐LE Fish oil lipid emulsion (LE) vs non‐fish oil LE | no estimate extracted | 1 study · 24 participants | Low Downgraded: imprecision |