477 - Relationship between Parenteral Multi-Component Fish-Oil-Rich Lipid Emulsion and Bronchopulmonary Dysplasia in Extremely Preterm Infants

Publication Number: 477.6343

Marwa M. Elgendy, University of Florida, Jacksonville, FL, United States; Josef Cortez, UF Health Jacksonville, Jacksonville, FL, United States; Kevin M. Vogt, University of Florida College of Medicine, ponte vedra, FL, United States; Doaa El Amrousy, Faculty of Medicine, Tanta University, Egypt, Tanta, Al Gharbiyah, Egypt; Abdelrahman Mohamed. Elmashad, Faculty of Medicine Tanta University, Tanta, Al Gharbiyah, Egypt; William Renfro, UF Health Jacksonville, Jacksonville, FL, United States; Mark L. Hudak, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States; Vasantha HS. Kumar, University of Florida College of Medicine, Jacksonville, Jacksonville, FL, United States

Background: Extremely premature infants (EPI, gestational age < 28 weeks) are at risk for developing bronchopulmonary dysplasia (BPD). Parenteral nutrition including lipid emulsions is standard practice to support growth of EPI. SMOFlipid is a multicomponent lipid emulsion rich in omega-3 fatty acids that may downregulate inflammation pathways that contribute to the pathogenesis of BPD. We aimed to investigate the association between the administration of SMOFlipid and the development and severity of BPD among EPI.

Objective: To evaluate the relationship between the duration of SMOFlipid administration and the incidence and severity of BPD in EPI.

Design/Methods: We retrospectively analyzed outcomes in EPI admitted to the UF Health Jacksonville Hospital between January 2017 and December 2023. We defined BPD as respiratory support at 36 weeks' post-menstrual age and classified severity according to Jensen: grade 1 BPD requiring ≤2 liters per minute (L/min) of nasal cannula support (NC), grade 2 requiring >2 L/min of NC or noninvasive positive airway pressure, or grade 3 requiring invasive mechanical ventilation. We performed bivariate statistical analysis and included variables that were statistically significant in the regression analysis to establish the relationship between BPD severity and SMOFlipid.

Results: Among 332 EPI who survived to discharge, 189 (57%) were diagnosed with BPD (Table 1). There was no significant difference in gestational age or birth weight among the three BPD severity groups. In unadjusted analyses, total days of ventilation, duration of SMOFlipid administration, and severe IVH were significantly associated with BPD [ORs 1.50 (95% CI: 1.134–1.225, p< 0.001); 0.974 (95% CI: 0.952–0.997, p=0.024); and 2.13 (95% CI: 1.234–3.836, p=0.02), respectively].After adjusting for covariates, duration of SMOFlipid was no longer significantly associated with the severity of BPD [aOR: 0.986 (95% CI: 0.971–1.001, p=0.062), Table 2] but the associations of the duration of mechanical ventilation and severe IVH with severe BPD remained significant [aORs: 1.023 (95% CI: 1.008–1.038, p=0.003); 3.027 (95% CI: 1.316-6.963, p=0.009), respectively, Table 2].

Conclusion(s): Our data do not support the hypothesis that longer durations of SMOFlipid administration mitigate the severity of BPD but suggest that duration may be a marker of overall illness severity in EPI. We also found that the presence of one comorbidity (severe IVH) correlated with higher severity of BPD in EPI independent of other risk factors.

Table 1 - Comparison of BPD Severity
Table 1 - Comparison of BPD Severity.pdfGA: gestational age: BW: birth weight; SGA: small for gestational age; IVH: intraventricular hemorrhage

Table 2 - Logistic regression analysis of predictors for severe bronchopulmonary dysplasia
Table 2 - Logistic regression analysis of predictors for severe bronchopulmonary dysplasia.pdfGA: gestational age: BW: birth weight; SGA: small for gestational age; IVH: intraventricular hemorrhage