The Effect Of Lipid Emulsions Containing Fish Oil Versus Soybean Oil-based Lipid Emulsions On PN Associated Liver Disease In Preterminfants Receiving Parenteral Nutrition:a Meta-analysis

Objective:To investigate the effect of lipid emulsions containing fish oil versus soybean oil-based lipid emulsions on PN associated liver disease in preterm infants receiving parenteral nutrition.Method:The randomized controlled trials(RCTs)of using fish oil containing lipid emulsion for premature infants were searched from The Cochrane Library,PubMed,MEDLINE,the data bases of China National Knowledge Infrastructure(CNKI),Vip full-text database,Wanfang.And supplemented by literature review,manual retrieval and other methods.The deadline of retrieval is January,2018.The search terms were infant,premature,low birth weight,Parenteral nutrition,fish oils,omega-3 PUFAs,omega-3 fatty acids,eicosapentaenoic acid,docosahexenoic acid.Thetotal bilirubin(TBIL),direct bilirubin(DBIL),alanine amino transferase(ALT),glutamic oxalacetic transaminase(AST),triglyceride(TG),cholesterol(TC),glutamyltransferase(GGT),Alkaline phosphatase(ALP).The incidence of parenteral nutrition associated cholestasis(PNAC),etc were collected.Two researchers independently extracted the literature screening data according to the inclusion criteria,and according to the criteria of the Jadad,the quality of the included RCTs was evaluated and related data was extracted.TheWeighted meandifference(WMD),relative risk(RR)and 95% Confidence interval(CI)were used as effect indicators.Meta-analysis was performed with RevMan 5.3 software.Results:A total of 10 high-quality randomized controlled trials with 458 preterm infants,227 in the test group and 231 in the control group met the inclusion criteria.The results of Meta-analysis showed that compared with the Soybean oil lipid emulsion(SOLE),the fish oil lipid emulsion(FOLE)reduced the influence on GGT[WMD=-41.78,95%CI(-69.74,-13.82),P=0.003],and ALP[WMD=-103.59,95%CI(-183.55,-23.64),P=0.01],but there were no statistically significant differences in TBil,DBil,ALT,AST,TG,TC.The incidence of PNAC has no significantly decreased(P < 0.05)in ω-3 fish oil containing lipid emulsion group.Subgroup analysis on gestational age and formulation containing fish oil fat emulsion,the results showed that thetotal bilirubin in the preterm infants with gestational age ≤34 weeks whose receiving fish oil-based emulsion could decrease[WMD=-0.24,95%CI(-0.44,0.03),P=0.02].Publication bias was assessed by Funnel diagram and Egger’s test.No significant publication bias was found.Conclusion:(1)The GGT and ALP in the preterm infants whose receiving fish oil lipid emulsion could decrease.(2)The total bilirubin in the preterm infants with gestational age≤34 weeks whose receiving fish oil lipid emulsion could decrease.(3)Preterm infants receivd fish oil lipid emulsion would not benefit on the incidence of PNAC,liver function and lipid metabolism compared with soybean oil-based lipid emulsions.