Comparison of SMOF-Based and Soy-Based Parenteral Nutrition in Preterm Infants: A Retrospective and Prospective Analysis (Code-T0309)

Introduction: Preterm neonates with low birth weight require parenteral nutrition for adequate
growth and development. Lipid emulsions play a crucial role in total parenteral nutrition (TPN)
by providing essential fatty acids necessary for immune response, neurological development, and
reducing inflammation. Soy-based lipid emulsions (Intralipid) have been conventionally used but
are associated with oxidative stress. SMOF-based lipid emulsions, containing soybean oil,
medium-chain triglycerides, olive oil, and fish oil, have emerged as a potential alternative with
improved metabolic and clinical outcomes.
Aims and Objectives: The study aims to compare SMOF-based and soy-based lipid emulsions
in terms of their impact on neonatal outcomes, including sepsis, cholestasis, retinopathy of
prematurity (ROP), and overall tolerance in preterm infants.
Methods: A retrospective and prospective study was conducted at Rajarajeswari Medical
College and Hospital, Bengaluru, involving 50 preterm neonates receiving either SMOF-based or
soy-based lipid emulsions. Clinical parameters such as NICU stay duration, time to full feeds,
incidence of necrotizing enterocolitis, ROP screening, sepsis markers, liver function tests, and
lipid profile were analyzed. Statistical analyses included t-tests and chi-square tests for
significance assessment.
Results: SMOF-based emulsions demonstrated a lower incidence of cholestasis (p=0.01),
improved lipid tolerance (p=0.03), and reduced ROP severity (p=0.02) compared to soy-based
emulsions. However, no significant differences were observed in sepsis rates (p=0.08) or NICU
stay duration (p=0.09).
Conclusion: SMOF-based lipid emulsions offer better metabolic and clinical benefits compared
to soy-based emulsions in preterm neonates. Further large-scale studies are needed to validate
findings and optimize lipid emulsions for neonatal parenteral nutrition.
Keywords: Preterm infants, parenteral nutrition, lipid emulsions, SMOF, soy-based lipids,
neonatal outcomes.