Fish-oil fat emulsion supplementation reduces the risk of retinopathy in very low birth weight infants: a prospective, randomized study

JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):711-6. doi: 10.1177/0148607113499373. Epub 2013 Aug 20.


Background: Preliminary studies suggest that fish-oil lipid emulsion given parenterally to very preterm infants reduces the severity of retinopathy (ROP) and cholestasis.

Methods: Infants weighing <1250 g at birth were randomly allocated to 2 groups: an experimental group of 60 infants that received an intravenous (IV) soybean, olive oil, and fish oil emulsion, and a control group of 70 infants that was given a parenteral soybean and olive oil emulsion. Plasma and erythrocyte concentrations of docosahexaenoic acid (DHA) were determined using a high-performance liquid chromatography-mass spectrometry analysis.

Results: Nine infants in the fish oil group required laser therapy for ROP compared with 22 infants in the standard intralipid group (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.24-0.96). Three infants in the fish oil group developed cholestasis compared with 20 infants in the standard intralipid group (RR, 0.18; 95% CI, 0.055-0.56). The mean plasma DHA concentrations in treated infants were 2.9-fold higher in the fish oil group than in control infants on the 7th and 14th days of life. The mean DHA content in erythrocytes of treated infants was 4.5-fold and 2.7-fold higher compared with controls at 7 and 14 days of age.

Conclusions: Premature infants receiving an IV fat emulsion containing fish oil had less ROP requiring laser treatment and less cholestasis than those receiving a standard lipid emulsion. These infants also had higher plasma and erythrocyte DHA levels at 7 and 14 days, suggesting potential long-term neurodevelopmental benefits.

Keywords: Cholestasis; docosahexaenoic acid; fish oil emulsion; parenteral nutrition; retinopathy of prematurity; very low birth weight infant.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Child Development / drug effects
  • Cholestasis / blood
  • Cholestasis / prevention & control
  • Docosahexaenoic Acids / blood
  • Docosahexaenoic Acids / therapeutic use
  • Emulsions / therapeutic use
  • Fat Emulsions, Intravenous / therapeutic use*
  • Female
  • Fish Oils / therapeutic use*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight*
  • Male
  • Olive Oil
  • Parenteral Nutrition / methods
  • Phospholipids / therapeutic use
  • Plant Oils / therapeutic use
  • Prospective Studies
  • Retinopathy of Prematurity / blood
  • Retinopathy of Prematurity / prevention & control*
  • Soybean Oil / therapeutic use
  • Treatment Outcome


  • Emulsions
  • Fat Emulsions, Intravenous
  • Fish Oils
  • Olive Oil
  • Phospholipids
  • Plant Oils
  • soybean oil, phospholipid emulsion
  • Docosahexaenoic Acids
  • Soybean Oil