Use of SMOF lipid emulsion in very preterm infants does not affect the incidence of bronchopulmonary dysplasia–free survival

Background: We aim to assess whether the docosahexaenoic acid (DHA)–containing lipid emulsion (LE) SMOFlipid 20% (Fresenius Kabi Canada Ltd) is associated with bronchopulmonary dysplasia (BPD)–free survival at 36 weeks' postmenstrual age in very preterm infants. Methods: This cohort study is nested in the MOBYDIck randomized clinical trial (NCT02371460), which investigated the effect of maternal DHA supplementation on BPD-free survival in breastfed very preterm infants born between 23 0/7 and 28 6/7 weeks' gestation in 16 Canadian neonatal intensive care units (2015–2018). Parenteral SMOF-LE was given to the infants according to the sites' routine care protocols. Relative risks (RRs) were estimated using a modified Poisson regression model with generalized estimating equations taking into account recruitment site, multiple birth, DHA supplementation, birth weight, sex, and gestational age. Results: Among 528 infants (mean gestational age, 26.5 weeks [SD, 1.6]), 272 received SMOF-LE. Overall, 56.7% of the infants in the SMOF-LE group and 59.7% infants in the non–SMOF-LE group survived without BPD (adjusted RR, 0.94 [95% CI, 0.77–1.14]; P = 0.51). BPD rates were 39.3% in the SMOF-LE group vs 34.1% in the non–SMOF-LE group (adjusted RR, 1.10 [95% CI, 0.82–1.47]; P = 0.53). Severe BPD rates were 31.8% in the SMOF-LE group vs 28.8% in the non–SMOF-LE group (adjusted P = 0.59). Mortality was not significantly different between the SMOF-LE (6.7%) and non–SMOF-LE groups (9.5%; adjusted P = 0.40). Conclusion: In very preterm infants, intravenous DHA-containing SMOF-LE during the neonatal period was not associated with BPD-free survival.