Summary of findings 3. Alternative lipid emulsion (LE) versus soybean oil‐based LE (S‐LE) for parenterally fed preterm infants.
| Alternative‐LE vsS‐LE for parenterally fed preterm infants | |||||
| Patient or population: parenterally fed preterm infants Settings: neonatal intensive care unit Intervention: alternative‐LE Comparison: S‐LE | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Control | Alternative‐LE vsS‐LE | ||||
|
Growth rate – MS‐LE vs S‐LE |
— | The mean rate of weight gain in the intervention group was 2.67 g/kg/day lower (8.2 lower to 2.86 higher) | — | 60 (1 study) | ⊕⊕⊝⊝ Lowa,b |
|
Growth rate – OS‐LE vs S‐LE |
— | The mean rate of weight gain in the intervention group was 0.42 g/kg/day lower (5.15 lower to 4.3 higher) | — | 123 (2 studies) | ⊕⊕⊝⊝ Lowa,b |
|
PNALD/cholestasis (any definition) – OS‐LE vs S‐LE |
Study population (assumed risk 10%) | RR 1.0 (0.26 to 3.86) | 261 (4 studies) | ⊕⊕⊝⊝ Lowa,b | |
| 100 per 1000 | 100 per 1000 (26 to 386) | ||||
|
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – OS‐LE vs S‐LE |
Study population (assumed risk 10%) | RR 1.0 (0.15 to 6.82) | 159 (2 studies) | ⊕⊕⊝⊝ Lowa,b | |
| 100 per 1000 | 100 per 1000 (15 to 68) | ||||
|
Death before discharge – OS‐LE vs S‐LE |
Study population | RR 1.0 (0.21 to 4.82) | 224 (3 studies) | ⊕⊕⊝⊝ Lowa,b | |
| 27 per 1000 | 27 per 1000 (6 to 129) | ||||
|
Death before discharge – MS‐LE vs S‐LE |
See comment | See comment | Not estimable | 60 (1 study) | No events in either group |
|
Any ROP – OS‐LE vs S‐LE |
Study population | RR 0.98 (0.67 to 1.43) | 142 (3 studies) | ⊕⊝⊝⊝ Very lowa,b,c | |
| 292 per 1000 | 286 per 1000 (195 to 417) | ||||
|
Any BPD – OS‐LE vs S‐LE (sensitivity analysis) |
Study population | RR 1.01 (0.57 to 1.79) | 197 (3 studies) | ⊕⊕⊝⊝ Lowa,b | |
| 150 per 1000 | 151 per 1000 (85 to 268) | ||||
|
Culture‐positive sepsis – OS‐LE vs S‐LE |
Study population | RR 1.22 (0.54 to 2.78) | 164 (2 studies) | ⊕⊕⊝⊝ Lowa,b | |
| 110 per 1000 | 134 per 1000 (59 to 305) | ||||
|
Conjugated bilirubin levels – OS‐LE vs S‐LE |
— | The mean conjugated bilirubin levels in the intervention groups was 0.24 µmol/L lower (1.03 lower to 0.55 higher) | — | 310 (5 studies) | ⊕⊕⊝⊝ Lowa,b |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BPD: bronchopulmonary dysplasia; CI: confidence interval; LE: lipid emulsion; MS‐LE: medium‐chain triglyceride‐soybean oil‐based lipid emulsion; OS‐LE: olive oil‐soybean oil‐based lipid emulsion; PNALD: parenteral nutrition‐associated liver disease; ROP: retinopathy of prematurity; RR: risk ratio; S‐LE: soybean oil‐based lipid emulsion. | |||||
| GRADE Working Group Grades of Evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | |||||
aDowngraded by one level as optimal information size not reached. bDowngraded by one level as the CI crossed the null effect and the limit of appreciable harm or benefit (0.75 or 1.25); or crossed limit of clinically appreciable harm or benefit in a continuous outcome (author consensus). cDowngraded by one level as one study was at high risk of material bias.