A Comparative Study of the Effects of Lipid Formulations on Retinopathy of Prematurity

INTRODUCTION: Retinopathy of Prematurity (ROP) is the leading cause of visual morbidity in premature infants. Omega-3 PUFA concentrated in fish oil has been shown to reduce ROP risk through its anti-ischemic, anti-inflammatory, and antioxidant properties. The SMOFlipid formulation is a rich omega‑3 source and may reduce ROP risk. We aimed to compare the ROP incidence and severity in preterm VLBW (<1501 g) infants receiving Intralipid versus SMOFlipid. METHODS: In a single-center, retrospective cohort study, we enrolled 493 preterm VLBW infants born between 2014 and 2022 at < 30 weeks GA and /or <1501g, who received either Intralipid or SMOFlipid, and were examined for ROP. RESULTS: There was no difference between the Intralipid and the SMOFlipid groups in the incidence of ROP (41.8% versus 37.1%, P=0.291) and its severity (P=0.313). Still, the SMOFlipid group had significantly higher rates of Plus (+) disease (P<0.001). Gestational age, birth weight, mode of delivery, use of steroids, length of lipid use, use of inotropes, hyperglycemia requiring insulin, and length of hospitalization were independent predictors of ROP. PDA, sepsis, NEC, BPD, and IVH were also independently associated with ROP on multivariate analysis. DISCUSSION: The study groups were comparable. Despite its omega‑3 content, evidence on SMOFlipid's effect on ROP remains inconsistent. The increased risk of disease suggests other unmeasured factors may influence severe ROP. As the largest study comparing IL and SMOFlipid, the preventive effect of SMOFlipid remains uncertain. CONCLUSION: The impact of SMOFlipid on the incidence and severity of ROP is comparable to that of soy-based lipid emulsions.