Comparision of Smof Based and Soy (Intra Lipid) Based Parenteral Nutrition Among Preterm Infants -a Retrospective and Prospective Study

Introduction: Preterm infants, particularly those with very low birth weight (VLBW <1500 g), often face nutritional challenges due to gastrointestinal immaturity and increased metabolic demands. Parenteral nutrition (PN) plays a critical role in meeting their early nutritional needs, with lipid emulsions serving as vital energy sources and providing essential fatty acids. Conventional soybean oil-based emulsions (Intralipid) have been associated with pro-inflammatory effects and parenteral nutrition-associated liver disease (PNALD). SMOF, a multi-component lipid emulsion composed of soybean oil, medium-chain triglycerides, olive oil, and fish oil, has been introduced to overcome these limitations. Aim and Objective: To compare SMOF-based and soybean oil-based lipid emulsions regarding growth parameters, risk of metabolic bone disease (MBD), sepsis, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and overall outcomes in preterm neonates. This combined retrospective and prospective observational cohort study was conducted at the Materials and Methods: NICU of Rajarajeswari Medical College and Hospital, Bangalore. Preterm neonates (<37 weeks, <2.5 kg) requiring PN >5 days were enrolled between April 2023 and September 2024. Demographic, clinical, biochemical, and outcome data were collected. Ethical clearance and parental consent were obtained. SMOF recipients showed significantly better birth weight (p = 0.003), earlier attainment of Results: full feeds (p = 0.021), improved weight gain (p = 0.001), and earlier initiation of breastfeeding (p = 0.019). Serum phosphorus levels were significantly higher (p = 0.005) in SMOF, suggesting reduced MBD risk. Rates of sepsis, NEC, BPD, and ROP were comparable across groups. SMOF l Conclusion: ipid emulsions demonstrated superior clinical benefits over Intralipid, enhancing nutritional outcomes without increasing complications, thus representing a preferable PN option in preterm infants.