Systematic Review 2014:
The impact of providing a combination of Lipid emulsion vs soya based lipid emulsion on bilirubin, TGs and infection in children. Finn KL,etal JPEN 2014;
9 Studies comparing Fish oil containing lipid emulsion with standard Soy based Lipi emulsion
Goulet 2010
- N=28
- RCTs
- SMOFvs Intralipid
- Dose:1.4g/kg/d
- Period:28 days
- Enteral: ND
- SBS on Home PN
Skouroliako 2010
- N=19
- RCTs
- SMOF vs Intralipid
- Dose:~2.2g/kg/d
- Period:41vs28days
- Enteral: <20% TE
- Prems
Tomsits 2010
- N=30
- RCTs
- SMOF vs Intralipid
- Dose:1.6g/kg/d
- Period:~11days
- Enteral: <50% TE
- Prems
- Conclusions:
- Potential benefit cholestasis
Rayyan 2012
- N=53
- RCTs
- SMOF vs Intralipid
- Dose:2.1g/kg/d
- Period:7-14days
- Enteral: <70% TE
- Prems
Muhammed 2012
- N=17
- Retro cohort
- SMOF vs Intralipid
- Dose:2g/kg/d [soya 3.5]
- Period:6months
- Enteral: ~30-50kcal/kg/day
- Children with PNALD
Lilja 2011
- N=5
- Single arm trial
- 1:1Clin+Omeg vs Intralipid
- Dose:~2g/kg/d
- Period:7-17months
- Enteral: unclear
- Prems with SBS
Angsten 2012
- N=38
- Retro cohort
- 1:1Clin+Omeg vs Intralipid
- Dose:2g/kg/d
- Period:8.3 months
- Enteral:ND
- Infants with SBS
Savini 2013
- N=144
- RCTs [5arm trial]
- SMOF OR Lipoplus vs Intralipid
- Dose:ND
- Period:21days
- Enteral: unclear
- Prems
Larsen 2012
- N=36
- RCTs
- Lipoplus vs Intralipid
- Dose:~19g/d
- Period:14 days
- Enteral: <30kcal/kg/day
- Infants scheduled cardiac surgery
6 of the 9 studies reported on Total Bilirubin
- 4 showing favourable effects using combination LE
- Meta-analysis though showed no significant difference , but showed decrease trend TB
- The other 2 studies showed significant difference TB
Incidence of infections:
- 6/9 reported incidences
- Meta-analysis showed no significant difference
- Concerns: definition was unclear/inconsistent
Other results:
- Triglycerides and adverse events – no significant difference
- Deaths – 6/9 reported no deaths
Limitations:
- Small studies with different designs/populations and Enteral nutrition
- Protocols were different between centres
- Short duration of RCTs – 10 – 41 days
- Type of enteral nutrition was unclear
Conclusion:
- Use of combination lipid emulsions were safe & tolerated
- Inadequate evidence – benefit for Total bilirubin, Triglycerides, infection
- But individually did show favourable effects on Total bilirubin
- Larger RCTs required to determine if superior