Systematic Review Of A Novel Lipid Emulsion (SMOFlipid)in Preterm Infants Receiving Parenteral Nutrition:a Meta-analysis Of Randomized Controlled Trials

Objective:The objective was to assess the efficacy and safety of a new parenteral lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid20%) for parenteral fed premature infants.Methods:A search of PUBMED, EMBASE, Cochrane library, CBM and CNKI for randomized controlled trials (RCTs) of SMOFlipid for parenteral fed premature infants was undertaken, from the date of their establishment to January,2014. According to the criteria of the Cochrane Handbook, quality of the included RCTs was evaluated and related data was extracted. Meta-analyses were performed with RevMan5.2software, and then the level of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) software.Results:The search yielded287publications and abstracts,6randomized controled trials(RCTs) were included after screening, including323parenteral fed preterm infants,160in the test group and163in the control group. No statistically significant differences were observed between SMOFlipid group and Intralipid group for the time to regain birth weight, rate of birth weight gain(1st week), mortality, duration of hospitalization, duration of ventilation or oxygen therapy, incidence of cholestasis, sepsis, NEC, BPD, incidence of severe adverse events, but the incidence of ROP was significantly reduced in the SMOFlipid group. No significant differences were found between SMOFlipid group and Clinoleic group for mortality and incidence of BPD. Quality of the evidences based on the GRADE system were predominatly moderate or low quality. Conclusions:SMOFlipid emulsion was safe, well tolerated and efficacious for parenterally-fed preterm infants, same dose of SMOFlipid and LCT could supply comparative calorie, which could satisfy the energy demand for the early development after birth. Besides, SMOFlipid was of great benefit in lowering the incidence of ROP, but showed no effect on improving the other clinical outcomes. Besides, data extracted from the six included studies was limited, quality of the evidences based on the GRADE system was predominantly moderate or low.