Influence of different intravenous lipid emulsions on growth, development and laboratory and clinical outcomes in hospitalised paediatric patients: A systematic review.

Background & Aims: Fats in the form of lipid emulsions (LEs) are an integral part of intravenous nutrition. The fatty acid composition of different LEs varies. The exact composition of a LE may influence cell and tissue function and clinical outcome. Currently, it is not clear which LE might be best for paediatric patients. We conducted a systematic review of the effects of different intravenous LEs in hospitalised paediatric patients.

Methods: Randomised controlled trials published in a peer reviewed journal, written in the English language, and comparing two or more different intravenous LEs in hospitalised paediatric patients were included. Data on outcomes of relevance (growth, development, laboratory and clinical outcomes) were extracted, collated and interpreted.

Results: Thirty-one articles involving 1522 infants or children were included. Most outcomes were not affected by the nature of the LE used. LEs containing fish oil, a source of omega-3 fatty acids, improved outcome of retinopathy of prematurity, decreased liver cholestasis and increased blood omega-3 fatty acid levels. LEs containing olive oil increased blood oleic acid level and had a cholesterol lowering effect.

Conclusion: Blood fatty acids are influenced by the nature of the intravenous LE used in hospitalised paediatric patients. Most studies suggest limited differences in relevant laboratory or clinical outcomes or in growth in paediatric patients receiving different LEs, although several studies do find benefits from including fish oil or olive oil. There is a need for larger trials to fully evaluate the effects of the available LE types in hospitalised paediatric patients.