Growth and clinical outcome in very low birthweight infants after the introduction of a multicomponent lipid emulsion

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dc.contributor.advisor Bloomfield, F en
dc.contributor.advisor Cormack, B en Hill, Nicole en 2017-08-02T02:56:47Z en 2017 en
dc.identifier.uri en
dc.description Full text is available to authenticated members of The University of Auckland only. en
dc.description.abstract Very low birthweight (VLBW; birthweight <1,500 g) infants are dependent on parenteral nutrition after birth. Conventional intravenous lipid emulsions are associated with inflammatory and metabolic complications which may be harmful to preterm infants. Evidence to support any clinical benefit associated with newer multicomponent emulsions, in particular those enriched with omega-3 fatty acids, remains inconsistent and unsubstantiated in appropriate studies. The aim of this thesis 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 infants born in the neonatal unit at National Women’s Health, Auckland City Hospital. A review of red blood cell transfusions before and after a contemporaneous change to the protocol on commencement of ferrous sulphate supplementation was also conducted. Consecutively-born VLBW infants were identified from a prospectively-maintained database of admissions. Data were collected retrospectively for the first four weeks after birth on nutritional intake, growth parameters, bilirubin concentrations, red blood cell transfusions, and a range of neonatal morbidities. Outcomes were compared between the two lipid cohorts with Student’s t-test or the Wilcoxon Rank Sum test. Data were available for 105 infants who received Intralipid and 102 infants who received SMOFlipid. There was no difference in growth velocity or change in weight, length and head circumference Z-scores between cohorts. Significantly fewer infants in the SMOFlipid cohort developed any retinopathy of prematurity (Intralipid 59% vs. SMOFlipid 39%, p=0.005) or intraventricular haemorrhage (Intralipid 27% vs. SMOFlipid 15%, p=0.03) during their admission. Receiving SMOFlipid was associated with significantly lower mean (p=0.01), minimum (p=0.03) and maximum (p=0.04) total bilirubin concentrations across the first four weeks after birth. SMOFlipid infants received ferrous sulphate supplementation significantly earlier (Intralipid 29 (28–30) days vs. SMOFlipid 18 (15–25) days, p<0.0001) and received one fewer red blood cell transfusions (Intralipid 2 (0–5) vs. SMOFlipid 1 (0–3) transfusions, p=0.02). This was associated with meeting international consensus recommendations for total enteral iron intake 13 days earlier. These data indicate that SMOFlipid may represent a favourable alternative to conventional lipid emulsions in neonatal parenteral nutrition regimens. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof Masters Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264967512802091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights Restricted Item. Available to authenticated members of The University of Auckland. en
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dc.title Growth and clinical outcome in very low birthweight infants after the introduction of a multicomponent lipid emulsion en
dc.type Thesis en Nutrition and Dietetics en The University of Auckland en Masters en
dc.rights.holder Copyright: The author en
pubs.elements-id 643865 en Liggins Institute en LiFePATH en
pubs.record-created-at-source-date 2017-08-02 en

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