Association between SMOF lipid and parenteral nutrition–associated cholestasis compared with Intralipid in extremely low birth weight infants: A retrospective cohort study

Background There is limited evidence on benefits of SMOF lipids (mixed fatty acid emulsion of 30% soybean oil, 30% medium chain triglycerides, 25% olive oil, and 15% fish oil) in reducing parenteral nutrition–associated cholestasis in extremely low birth weight infants, compared with soybean oil–based Intralipid. Aim To compare incidence of parenteral nutrition–associated cholestasis in preterm infants who received Intralipid vs SMOF lipid. Methods We conducted a retrospective study on infants with birth weight <1000 g, admitted between January 2013 to December 2022, who received parenteral nutrition for >14 days and divided them into two groups based on lipid emulsion received (Intralipid, n = 187, SMOF, n = 127). Primary outcome was incidence of parenteral nutrition–associated cholestasis, defined as direct bilirubin ≥2 mg/dl. Results Baseline characteristics did not differ between the two groups. No significant difference was noted in parenteral nutrition–associated cholestasis between the two groups on logistic regression, (adjusted odds ratio: 0.71, 95% confidence interval 0.35–1.42, P value 0.33) after adjusting for gestational age, parenteral nutrition days, lipid days, and late‐onset sepsis. Conclusion There was no difference in the rates of parenteral nutrition–associated cholestasis between preterm infants administered SMOF lipids and those given Intralipid.