Parenteral nutrition with fish oil-based lipid emulsion reduces the risk of cholestasis in preterm infants.

OBJECTIVE: Preterm infants receive long-term parenteral nutrition (PN) for gastrointestinal immaturity. This study aimed to determine if mixed lipid emulsions containing fish oil decrease the incidence of PN-associated cholestasis by reducing oxidative stress and providing an anti-inflammatory effect. METHODS: This retrospective cohort study enrolled 399 very low birth weight premature infants (gestational age ≤32 weeks) between January 2009 and November 2017 at a single neonatal intensive care unit. Preterm infants received total PN with either mixed lipid emulsion including fish oil (SMOFlipid®, n = 195) or soybean oil-based lipid emulsion (Lipovenoes®, n = 204) for at least 7 days. We compared the outcomes of PN-associated cholestasis, comorbidities, and mortality between the groups. RESULTS: The incidence of PN-associated cholestasis was significantly lower in the SMOFlipid group than in the Lipovenoes group. The duration to full feeding days was significantly shorter in the SMOFlipid group compared with the Lipovenoes group. Relevant complications, such as severe retinopathy of prematurity and bronchopulmonary dysplasia, were also significantly reduced in the SMOFlipid group compared with the Lipovenoes group. CONCLUSION: In premature infants, PN with fish oil-based lipid emulsions is associated with a lower incidence of PN-associated cholestasis compared with soybean oil-based lipid emulsions.

Effects of fish oil-containing lipid emulsions on retinopathy of prematurity in very low birth weight infants.

BACKGROUND: The aim of the study was to assess the impact of different types of parenteral emulsions on retinopathy of prematurity (ROP) in very low birth weight (VLBW, birth body weight < 1500 g) infants by comparing fish oil-containing and soy-based parenteral emulsions. METHODS: Data of preterm infants with body weights below 1500 gm at birth and receiving total parenteral nutrition (TPN) for a minimum of 7 days during the period between January 2009 and November 2017 were analyzed in this retrospective study. We compared clinical outcomes in two epochs using different lipid emulsions: epoch 1 (soybean-based lipid emulsions, January 2009-February 2014) versus epoch 2 (fish oil-containing lipid emulsions, January 2015-November 2017). The primary outcomes measured were the incidence of ROP and the number of ROP cases requiring bevacizumab therapy. RESULTS: A total of 396 infants were enrolled in this study (203 in epoch 1 and 193 in epoch 2). A lower incidence of any stage ROP (24.1 vs. 11.4%, p < 0.001) and lower requirement of bevacizumab therapy (12.8 vs. 5.2%, p = 0.001) were observed in epoch 2. Gestational age, glutamic-pyruvic transaminase, total bilirubin, and alkaline phosphatase levels, and type of lipid emulsion in TPN were associated with higher ROP incidence. Multivariate logistic regression analysis revealed that parenteral nutrition in the form of lipid emulsions containing fish oil was associated with a lower risk of development of ROP [Odds Ratio: 0.178, 95% confidence interval (CI): 0.095-0.330, p < 0.001]. CONCLUSIONS: Compared with soybean-based lipid solutions, the use of fish oil-containing lipid solutions may be associated with a lower incidence of ROP and decreased need for bevacizumab treatment in preterm infants.

Intravenous fish oil containing lipid emulsion attenuates inflammatory cytokines and the development of bronchopulmonary dysplasia in very premature infants: A double-blind, randomized controlled trial.

BACKGROUND & AIMS: Preterm infants have lower levels of long-chain polyunsaturated fatty acids (LCPUFAs). Supplementing very premature infants with intravenous lipid emulsions that fish oil, which is rich in n-3 LC-PUFAs, may decrease bronchopulmonary dysplasia (BPD) by modulating inflammation and neonatal immune function. METHODS: Sixty very low birth weight (VLBW) premature infants requiring ventilator support were randomized in a double-blind manner to 2 groups and received total parenteral nutrition with fish oil containing LE (intervention group, n = 30) or soybean oil containing LE (control group, n = 30) for 7 days. Blood samples and bronchoalveolar lavage fluid (BALF) were obtained for assay on day 1 and 7 days after LE. The primary outcome was to compare the levels of interleukin (IL)-1ß and IL-6 in serum and BALF. Secondary outcomes were to compare mortality and co-morbidities. RESULTS: The levels of IL-1ß and IL-6 in serum and BALF were significantly lower in the intervention group at day 8 (p < 0.05). The incidence of BPD in the intervention group compared to the control group was 13.3% versus 36.7% (p = 0.04; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.86). The duration of ventilator support and oxygen use was significantly less in the intervention group than in the control group (p < 0.05). The level of alanine aminotransferase was significantly lower in the intervention group on day 8 (p = 0.031). CONCLUSIONS: In very premature infants, early administration of fish oil containing LE significantly decreased IL-1ß and IL-6 levels in serum and BALF and was associated with shorter duration of ventilator support and less bronchopulmonary dysplasia (BPD). TRIAL REGISTRATION NUMBER: ISRCTN 11427103.

Using Ultrasonography Measurements to Determine the Depth of the GB 21 Acupoint to Prevent Pneumothorax.

INTRODUCTIONS: Pneumothorax is the most frequent severe acupuncture-related adverse event occurring at the GB 21 acupoint. This study used ultrasonography (US) to measure the depth of the GB 21 acupoint in adults and assessed its applicability for ensuring safe acupuncture practices. MATERIALS AND METHODS: A US probe was used to measure the vertical depth from the skin to the pleural line of the apex of the lungs at the right and left GB 21 acupoints. The sex, age, body weight, height, and body mass index of each person were recorded. Student t test and generalized estimating equations were used for statistical analysis. RESULTS: Sixty women and 41 men with a median age of 29 years were included in this study. The depth of GB 21 increased with body weight, height, and body mass index (p < 0.001). The mean depth of GB 21 in men (17.4 mm) was greater than that in women (14.6 mm; p < 0.001). The depth difference between the right and left shoulders was significant in men (p < 0.001) but not in women. CONCLUSIONS: US can be used to measure GB 21 acupoint depth. Further control studies on its use to ensure safe clinical practices, including preventing acupuncture-related pneumothorax, are warranted.

The therapeutic depth of abdominal acupuncture points approaches the safe depth in overweight and in older children.

OBJECTIVES: Few studies have reported on the relative ratio between the depths to which acupuncture needles are inserted in therapy (therapeutic depth) and safety depth (the distance from the surface of the skin of the acupoint to the transverse fascia). This ratio may be of clinical importance because it may have an impact on the safety and the therapeutic effectiveness of acupuncture. DESIGN: We retrospectively studied children aged 7 to 15 years who underwent abdominal computed tomography (CT) at our hospital during the period January 1997-March 2006. Twelve (12) abdominal acupuncture points (CV-3, CV-4, CV-6, CV-10, CV-12, CV-14, KI-12, ST-24, ST-25, SP-15, LV-13, and LV-4) were measured directly on the CT images. The ratio between the therapeutic depth and safe depth of the 12 abdominal acupoints with factors sex, body weight, age, and waist girths were analyzed by one-way analysis of variance and multiple linear regression analysis. RESULTS: A total of 204 patients were included in this study. There was no significant difference in the therapeutic depth over safety depth ratio (T/S ratio) between genders. The T/S ratio of these 12 acupuncture points ranged from 0.67 to 0.88 and increased significantly with body weight, age, and waist girth (p < 0.001). CONCLUSIONS: The therapeutic depth of abdominal acupoints is closer to the safe depth in overweight and in older children aged 7 to 15 years old. There was no significant difference between genders.

Safe depth of abdominal acupoints in pediatric patients.

OBJECTIVES: To evaluate the depths to which acupuncture needles can be inserted safely (safe depth) in 12 abdominal acupoints in pediatric patients. This study also evaluates the variations in safe depth according to sex, age, body weight, and waist girth. DESIGN: We retrospectively studied computerized tomography (CT) images of pediatric patients aged 7-15 years who had undergone abdominal CT scans at our hospital from January 1997 to March 2006. The safe depth of 12 acupoints along the conception vessel (CV) meridian (Renmai), CV-2 to CV-7 and CV-9 to CV-14, were measured directly on the CT images. The relationship between the safe depth of these acupoints and sex, age, body weight and waist girth was analyzed by one-way ANOVA and multiple linear regression analysis. RESULTS: A total of 219 patients were included in this study. Except for CV-2, there was no significant difference in safe depth of the other 11 acupoints between sexes. The safe depth of all 12 CV acupoints increased significantly (P<0.001) with age, body weight and waist girth. There were large variations in the safe depth of the 12 points among different age and body weight groups. The safe depths were 1.3-2.1 times deeper in the 12-15-year-old group than in the 7-9-year-old group, and 1.7-3 times deeper in overweight children than in underweight children. CONCLUSION: The safe depth to which the 12 abdominal CV meridian acupoints can be needled significantly increases with age, body weight and waist girth in pediatric patients aged 7-15 years. Physicians who perform acupuncture in pediatric patients should be aware of the large variations in safe depth of acupoints to prevent possible complications.