Lipids are essential components of parenteral nutrition for preterm infants. Parenteral lipids can be administered through a peripheral vein, and their early introduction offers the potential advantages of increasing energy intake and providing essential fatty acids and fat soluble vitamins. Concerns have been raised about potential adverse effects including chronic lung disease (CLD), increase in pulmonary vascular resistance, impaired pulmonary gas diffusion, bilirubin toxicity, sepsis and free radical stress.
To determine the safety and efficacy of 'early' (≤ 5 days after birth) introduction of lipids to parenterally fed preterm infants.
Eligible studies were identified by searching MEDLINE (December 2004), EMBASE 1980 - 2004, Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004) and CINAHL (December 1982 - December 2004). Abstracts of the Society for Pediatric Research were hand searched from 1980 to 2004 inclusive. No language restrictions were applied.
All randomised or quasi randomised controlled trials comparing 'early' versus 'no early' introduction of lipids to preterm infants.
Data collection and analysis
Data were sought regarding effects on growth and risk of CLD or death, other respiratory morbidities including duration of respiratory support, duration of supplemental oxygen, the need for home oxygen, pneumothorax (PTX), pulmonary haemorrhage and pulmonary interstitial emphysema (PIE), ≥ stage 2 necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), sepsis, intraventricular haemorrhage (IVH), clinically significant thrombocytopenia and significant jaundice. Methodological quality of eligible studies was assessed according to allocation concealment, blinding of intervention, blinding of outcome assessment and completeness of follow up. When appropriate, meta-analysis was conducted to provide a pooled estimate of effect. For categorical data the Typical relative risk (RR), Typical risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals (CI) were calculated. Continuous data were analysed using weighted mean difference (WMD).
Five studies (n = 397) were included in the review. All studies compared the effectiveness and safety of 'early' introduction versus 'no early' introduction of lipids in preterm infants. The timing of introduction of 'early lipids' ranged from < 12 hours after birth to day five of life. The timing of introduction of lipids in the 'no early' lipid group ranged from day six after birth to day 14 after birth. The initial dose ranged from 0.5 - 1 g/kg/day with gradual daily increments up to a maximum of 2.5 - 3.5 g/kg/day.
For the primary outcomes (growth, death and CLD), there was no statistically significant difference between the 'early' lipid and 'no early' lipid groups.
Days to regain birth weight: [WMD 0.59 (95% CI -2.41, 3.58); two trials; N = 71].
Rate of weight gain (g/day) during period of hospital stay: [MD -2.40 (95% CI -5.30, 0.50); one trial; N = 129]
Death (irrespective of time): [Typical RR 1.04 (95% CI 0.69, 1.56); Typical RD 0.01 (95% CI -0.07, 0.08); five trials; N = 397]
Neonatal deaths: [Typical RR 1.35 (95% CI 0.78, 2.34); Typical RD 0.05 (95% CI -0.04, 0.13); four trials; N = 268].
CLD: [Typical RR 1.10 (95% CI 0.81, 1.49); Typical RD 0.04 (95% CI -0.09, 0.17); two trials; N = 193].
For the secondary outcomes of other respiratory morbidities including duration of respiratory support, duration of supplemental oxygen, PTX, pulmonary haemorrhage, PIE, NEC, ROP, PDA, sepsis, IVH and significant jaundice, there were no statistically significant differences between 'early' and 'no early' lipid groups.
No statistically significant effects of 'early introduction' of lipids on short term nutritional or other clinical outcomes, either benefits or adverse effects, were demonstrated in the studies reviewed. Based on the currently available evidence, 'early' initiation of lipids (≤ 5 days after birth) can not be recommended for short term growth or to prevent morbidity and mortality in preterm infants.
脂肪是早產兒靜脈營養的必要成分。 經靜脈脂肪可以經由周邊靜脈給予，早期給予所提供的好處包括有增加攝取的能量，提供必需脂肪酸和脂溶性維生素等。 但仍有疑慮其潛在的副作用，包括慢性肺疾病(CLD)、增加肺血管阻力、肺部氣體交換受損、膽紅素毒性、敗血症和自由基的傷害等。
經由搜尋 MEDLINE(December 2004), EMBASE 1980 – 2004, Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004)及CINAHL (December 1982 December 2004)找出合乎條件的研究，並以書面搜尋Society for Pediatric Research由1980年至2004年之摘要，無語言限制。
收集有關對生長的影響、慢性肺疾病或死亡之風險、及其他對呼吸系統之傷害如仰賴呼吸器的時間、使用氧氣的時間、出院後氧氣的使用、氣胸、肺出血、肺間質氣腫、第二期以上之壞死性腸炎、早產兒視網膜病變、開放性動脈導管、敗血症、腦室內出血、臨床上有意義之血小板低下症及有意義之黃疸之資料。 合格研究的方法品質是根據分配的隱閉性、實驗介入的盲性、結果評估的盲性及後續追蹤的完整性來評估的。適當的時候並應用統合分析來作為資料的整體評估。針對類別資料計算其典型的相對危險(RR)、危險差(RD) 、必須治療數(NNT)及95%信賴區間(CI)，針對連續資料計算其加權的平均差(WMD)。
一共有五項研究(共397人)被納入，所有的研究都比較早期給予和非早期給予經靜脈脂肪對早產兒的有效性和安全性。早期給予脂肪的時機從出生後12小時內到出生後第5天，非早期給予脂肪的時機從出生後第6天到第14天。開始的劑量從0.5 1 g/kg/day，之後每天增加到最多2.5 3.5 g/kg/day。 對於主要結果(生長、死亡及慢性肺疾病)，在早期和非早期給予脂肪這兩組之間並無顯著的統計學差異。 回到出生體重的天數：[WMD 0.59 (95% CI −2.41, 3.58); two trials; N = 71]，在醫院期間體重成長的速度(g/day)：[MD −2.40 (95% CI −5.30, 0.50); one trial; N = 129]。死亡(不管任何時間)：[Typical RR 1.04 (95% CI 0.69, 1.56); Typical RD 0.01 (95% CI −0.07, 0.08); five trials; N = 397] ，新生兒期死亡：[Typical RR 1.35 (95% CI 0.78, 2.34); Typical RD 0.05 (95% CI −0.04, 0.13); four trials; N = 268]，慢性肺疾病：[Typical RR 1.10 (95% CI 0.81, 1.49); Typical RD 0.04 (95% CI −0.09, 0.17); two trials; N = 193]。 針對次要結果其他對呼吸系統之傷害包括仰賴呼吸器的時間、使用氧氣的時間、氣胸、肺出血、肺間質氣腫、壞死性腸炎、早產兒視網膜病變、開放性動脈導管、敗血症、腦室內出血及有意義之黃疸之資料，在早期和非早期給予脂肪這兩組之間並無顯著的統計學差異。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。