Summary of findings 5. Fish oil lipid emulsion (LE) compared to non‐fish oil LE in parenterally fed preterm infants with surgical conditions.
| Fish oil LE compared to non‐fish oil LE in preterm infants with surgical conditions for parenterally fed preterm infants | ||||||
| Patient or population: parenterally fed preterm infants with surgical conditions Settings: NICU Intervention: fish oil LE (pure F‐LE) Comparison: non‐fish oil LE (S‐LE) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Non‐fish oil LE in preterm infants with surgical conditions | Fish oil LE | |||||
|
PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL) – pure F‐LE vs S‐LE |
Study population | RR 1.11 (0.08 to 15.28) | 19 (1 study) | ⊕⊝⊝⊝ Very lowa,b,c,d | — | |
| 100 per 1000 | 111 per 1000 (8 to 1000) | |||||
|
Death before discharge – pure F‐LE vs S‐LE |
See comment | See comment | Not estimable | 19 (1 study) | — | No events in either group |
|
Culture‐positive sepsis – pure F‐LE vs S‐LE |
Study population | RR 1.11 (0.39 to 3.19) | 19 (1 study) | ⊕⊝⊝⊝ Very lowa,b,c,d | — | |
| About 400 per 1000 | 444 per 1000 (156 to 1000) | |||||
|
Conjugated bilirubin levels – pure F‐LE vs S‐LE |
— | The mean conjugated bilirubin levels in the intervention group was 0 µmol/L higher (11.3 lower to 11.3 higher) | — | 19 (1 study) | ⊕⊝⊝⊝ Very lowa,b,c,d | — |
|
Neurodevelopmental outcomes (6 months) – pure F‐LE vs S‐LE |
— | Study reported no significant difference in non‐parametric statistics | — | 11 (1 study) |
— | Grade of evidence was likely to be very low. Parametric statistics not available. |
|
Neurodevelopmental outcomes (24 months) – pure F‐LE vs S‐LE |
— | Study reported no significant difference in non‐parametric statistics | — | 10 (1 study) | — | Grade of evidence was likely to be very low. Parametric statistics not available |
| *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). CI: confidence interval; F‐LE: fish oil lipid emulsion; LE: lipid emulsion; PNALD: parenteral nutrition‐associated liver disease; 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). cThe evidence could be potentially further downgraded by one level for this outcome as it was a single small study. This downgrading would not apply if this was a large randomised study. dDowngraded by one level due to potential risk of bias due to early termination of study and due to use of 10% Intralipid.