Preterm infants supported with a multicomponent intravenous lipid emulsion saw improved brain development compared to those given a single-fat source, a new study finds. The research will be presented at the Pediatric Academic Societies (PAS) 2024 Meeting, held May 3-6 in Toronto.
Soybean-only lipid emulsions traditionally have been used in neonatal intensive care units to provide intravenous nutritional support to preterm infants, according to researchers. This study investigated the effects of newer multicomponent lipid emulsions, with fat sources derived from soybeans, olives, coconuts, and fish oil, on preterm brain development compared to soybean-only.
Researchers evaluated the impact of a variety of intravenous lipid emulsions on preterm brain development using magnetic resonance imaging, magnetic resonance spectroscopy, and early neurobehavioral assessments from 89 U.S. preterm infants born at or before 32 gestational weeks.
Researchers found that preterm infants receiving the multicomponent lipid emulsion demonstrated improved regional brain growth and biochemical markers of neuronal integrity, as well as superior neurobehavioral regulation, by term-corrected age. These findings could be due to the potential anti-inflammatory and antioxidant properties of the newer multicomponent lipids, the authors postulate.
“Preterm births account for more than 10% of all births in the United States, and the majority of very preterm infants experience neurological issues later in life,” said Katherine Ottolini, MD, attending neonatologist in the Developing Brain Institute at Children’s National Hospital and presenting author. “Early lipid intake is critical for preterm brain development, and our findings suggest that reformulated intravenous lipid products have the potential to enhance neurodevelopment in this particularly vulnerable population.”
Study authors recommend ongoing research on reformulated intravenous lipid emulsions be conducted to assess long-term neurodevelopmental effects.
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EDITOR:
Dr. Katherine Ottolini will present “Type of Intravenous Lipid Emulsion Affects Very Preterm Brain Development” on Saturday, May 4 from 8:45-9:00 AM E.T.
Reporters interested in an interview with Dr. Ottolini should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information, please visit www.pas-meeting.org.
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Abstract: Type of Intravenous Lipid Emulsion Affects Very Preterm Brain Development
Presenting Author: Katherine M. Ottolini, MD
Organization
Children’s National Hospital and the George Washington University School of Medicine & Health Sciences
Topic
Neonatal Fetal Nutrition & Metabolism
Background
Intravenous lipid emulsions (ILEs) are an essential component of early preterm nutritional support. Multicomponent lipid emulsions (MLE) containing soybean, olive, coconut, and fish oil are being increasingly utilized over traditional soybean-only lipid emulsions (SLE); MLE contains higher ω-3 fatty acid and vitamin E levels with anti-inflammatory and antioxidant properties. The impact of MLE compared to ILE on preterm brain development has not been previously studied using multi-modal quantitative brain magnetic resonance imaging (qMRI) and magnetic resonance spectroscopy (MRS) techniques.
Objective
The aim of this study was to compare early brain growth and metabolism in very preterm infants receiving MLE versus SLE using qMRI and MRS at term equivalent age (TEA).
Design/Methods
We prospectively enrolled human milk-fed infants born at < 1500g and < 32 weeks gestational age (GA) admitted to our NICU within the first week of life; those with IVH (>Gr2) and parenchymal brain injury were excluded. Preterm infants born prior to 2019 received SLE (Intralipid); those born after 2019 received MLE (SMOFLipid). 3-D volumetric MRI and MRS (cerebellum, TE=35ms, TR=2000ms) were performed at TEA (Fig 1). We used ANCOVA to evaluate differences in TEA brain volumes and cerebellar metabolite levels based on ILE type, controlling for birth GA, age at MRI, and number of TPN days.
Results
Nutritional and MRI data were acquired for 80 preterm infants; on average infants who received MLE underwent TEA MRI later than SLE (40.6+/-1.6 vs. 39.3+/-2.1 weeks, p < 0.01), with no other significant differences in baseline patient characteristics (Table 1A). Infants receiving SLE demonstrated larger deep gray matter and amygdala-hippocampal volumes, whereas those receiving MLE demonstrated larger brainstem volumes (Table 1B). Cerebellar MRS revealed significantly higher creatine, lactate, inositol, gamma-aminobutyric acid, and glutamate levels in infants who received SLE compared to MLE (Table 1C).
Conclusion(s)
Preterm infants receiving MLE demonstrated distinct patterns of regional brain growth and cerebellar metabolism at TEA compared to SLE. Although infants receiving SLE demonstrated larger deep gray matter and amygdala-hippocampus volumes, they also exhibited increased lactate, a metabolite associated with brain injury, and inhibitory and excitatory neurotransmitters that could potentially signify disruptions in metabolic development. Further investigation is necessary and warranted to elucidate the effects of different types of ILEs on preterm brain development and assess the implications for long-term neurodevelopment.
Tables and Images
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Article Title
Type of Intravenous Lipid Emulsion Affects Very Preterm Brain Development