Fish oil-based lipid emulsion decrease inflammation and bronchopulmonary dysplasia in extremely premature infants

ISRCTN ISRCTN11427103
DOI https://doi.org/10.1186/ISRCTN11427103
Secondary identifying numbers 101-CCH-IRP-15
Submission date
07/09/2015
Registration date
15/09/2015
Last edited
27/06/2018
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Neonatal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Preterm infants have significantly lower long chain polyunsaturated fatty acids (LC-PUFA) concentrations than full term infants because they miss the major period of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) development in the brain and other organs during the third trimester of pregnancy. LC-PUFA play a potentially significant role in the modulation (control) of developmental processes affecting short- and long-term health outcomes related to growth, body composition, immune and allergic responses, and nutrition-related chronic disease. The most widely used formulation for parenteral (intravenous) nutrition (PN) is a soybean oil-based lipid emulsions (LE), which is rich in n-6 LC-PUFA and phytosterols which may cause liver toxicity and inflammation. LC-PUFAs (EPA and DHA) from fish oil may prevent the inflammatory response and even reduce any inflammation that exists. Early fish oil-based lipid emulsion (LE) administration to very low birth weight premature infants may reduce the development of chronic lung disease(CLD) and liver dysfunction by decreasing inflammatory cytokines (small signalling proteins) with IL-1β and IL-6 levels (suggesting inflammation) in serum (a component of the blood) and bronchoalveolar lavage fluid (fluid from the lungs). The aim of this study is to investigate whether this is the case.

Who can participate
Very low birth weight (VLBW) premature infants with a birth weight <1250gm or gestation age <32 weeks.

What does the study involve
Participants are randomly allocated into one of two groups. Those in group 1 are given total parenteral nutrition (TPN) containing a fish oil-based lipid emulsion. Those in group 2 are given TPN containing conventional soybean lipid emulsion. Treatment starts within 48 hours of birth and lasts for at least seven days. The dose starts at 1gm/kg but then increases by 1gm/kg per day until the maximum dose of 3gm/kg.

What are the possible benefits and risks of participating
The treatment may reduce the development of lung and liver problems by reducing inflammation

Where is the study run from
Changhua Christian Hospital (Taiwan)

When is study starting and how long is it expected to run
March 2012 to February 2014

Who is the main contact
Chien-Chou Hsiao
68206@cch.org.tw

Contact information

Dr Chien-Chou Hsiao
Scientific

135 Nanshiao Street
Changhua city
500
Taiwan

ORCiD logoORCID ID 0000-0002-4523-5300
Phone 886-4-7238595 ext 1902
Email 68206@cch.org.tw

Study information

Study designRandomised controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use contact details to request a participant information sheet
Scientific titleFish oil-based lipid emulsion attenuates inflammatory cytokines and development of bronchopulmonary dysplasia in extremely premature infants: a randomised controlled trial
Study objectivesThe aim of this study to is investigate whether giving preterm infants an early supply of long chain polyunsaturated fatty acids (LC-PUFA) and fish oil-based lipid emulsions (LE) containing ω-3 LC-PUFAs helps prevent the development of bronchopulmonary dysplasia (BPD) by modulating inflammation and neonatal immune function.
Ethics approval(s)Changhua Christian Hospital Institutional Review Board Committee A, 22/12/2011, ref: CCH-IRB-110909
Health condition(s) or problem(s) studiedInsufficent docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in premature babies
InterventionSixty very low birth weight (VLBW) premature infants were randomized to 2 groups:
1. Study group received total parenteral nutrition (TPN) containing fish oil-based lipid emulsion (SMOF lipid contain 30% soybean-LCT, 30% MCT, 25% olive oil and 15% fish oil).
2.Control group received TPN containing conventional soybean lipid emulsion (Lipovenoes MCT 20%).

Treatment was started within 48 hours of birth and then for at least the next 7 days. The dose of both lipid emulsions were 1 gm/kg at first day of TPN, increasing to 1 gm/kg per day until 3 gm/kg. Macronutrients were provided using the same products for glucose and amino acid solutions in both groups. The premature infant was fed by NG tube or bottle with breast milk or premature formula milk if breast milk was not enough.
Intervention typeSupplement
Primary outcome measureComparison of immune effects of Interleukin (IL)-1β and IL-6, assessed on the first 48 hours and 7 days after TPN use, including serum IL-1β and IL-6 and bronchoalveolar lavage fluid from tracheal aspiration if intubated infants. The levels of cytokines in the serum and bronchoalveolar lavage fluid were estimated by enzyme-linked immunosorbent assay.
Secondary outcome measures1. Mortality
2. Ventilator use days
3. Oxygen dependent days
4. Length of hospital stay (LOS)
5. Growth rate
6. Liver function
7. Parenteral nutrition associated cholestasis (PNAC)
8. Bronchopulmonary dysplasia (BPD)
9. Retinopathy of prematurity(ROP)
10. Necrotizing enterocolitis (NEC)
11. Intraventricular hemorrhage (IVH)
12. Nosocomial infection

Follow up program will finish when the infant is discharged.
Overall study start date01/03/2012
Completion date28/02/2014

Eligibility

Participant type(s)Patient
Age groupNeonate
SexBoth
Target number of participants60
Key inclusion criteriaPVLBW infants who weighed below 1250 gm and gestational age below 32 weeks
Key exclusion criteria1. Chromosomal disorders or lethal congenital abnormalities
2. Congenital cyanotic heart disease
3. Anatomic obstructive gastrointestinal pathologies, such as intestinal malrotation with or without volvulus, stenosis, or atresia, gastroschisis, omphalocele and Hirschsprung’s disease
4. Confirmed or family history of hereditary metabolic disorder
Date of first enrolment01/03/2012
Date of final enrolment25/02/2014

Locations

Countries of recruitment

  • Taiwan

Study participating centre

Changhua Christian Hospital
500
Taiwan

Sponsor information

Changhua Christian Hospital
Hospital/treatment centre

135 Nanshaio Street
Changhua city
500
Taiwan

Phone 886-4-7238595
Email 68206@cc.org.tw
ROR logo "ROR" https://ror.org/05d9dtr71

Funders

Funder type

Hospital/treatment centre

Changhua Christian Hospital
Private sector organisation / Other non-profit organizations
Alternative name(s)
CCH
Location
Taiwan

Results and Publications

Intention to publish date30/11/2015
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planNovember 2015. Will submit to BMJ
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/06/2019 Yes No

Editorial Notes

27/06/2018: Publication reference added.