Low‐dose versus standard dose of soybean‐based intravenous lipid emulsions in neonates: A systematic review and meta‐analysis

Background Lipid restriction strategies using soybean‐based intravenous lipid emulsions (SO‐ILE) have been proposed to mitigate the risk of parenteral nutrition‐associated liver disease in neonates. Objective To compare the effects of low‐dose versus standard‐dose SO‐ILE in neonates receiving parenteral nutrition. Methods A systematic search of PubMed, Embase, and Cochrane databases was conducted. Randomized controlled trials and nonrandomized cohort studies comparing low‐dose (1 g/kg/day) versus standard‐dose (2–3 g/kg/day) SO‐ILE were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Heterogeneity was assessed using the I 2 statistic. Statistical analyses were performed using Review Manager 5.4.1. The protocol was prospectively registered in PROSPERO (CRD420251057906). Results Nine studies, including 6 randomized trials and 3 cohort studies, comprising 634 neonates, were included. The mean gestational age in the low‐dose group was 32.2 ± 5.13 weeks. In the primary analysis restricted to randomized controlled trials, no significant differences were observed between low‐dose and standard‐dose SO‐ILE for PNAC (53.4% vs. 48.5%; RR 1.08; 95% CI [0.84–1.39]; P = 0.55; I 2 = 0%), mortality (5.7% vs. 6.2%; RR 0.99; 95% CI [0.34–2.88]; P = 0.99; I 2 = 0%), days of parenteral nutrition (MD –1.75 days; 95% CI [–7.06–3.55]; P = 0.52; I 2 = 0%), peak direct bilirubin levels, or weight at the end of the study period or at hospital discharge. Conclusion There is no difference between the use of low doses and standard doses of SO‐ILE in neonates receiving parenteral nutrition with respect to liver‐related, growth, or mortality outcomes.