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. 2019 Jun 4;2019(6):CD013163. doi: 10.1002/14651858.CD013163.pub2

Comparison 1. Fish oil lipid emulsion (LE) versus non‐fish oil LE (see Appendix 3).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Days to regain birth weight 3   Mean Difference (IV, Fixed, 95% CI) Subtotals only
1.1 MOFS‐LE vs S‐LE 3 234 Mean Difference (IV, Fixed, 95% CI) 1.12 [‐0.17, 2.41]
1.2 MOFS‐LE vs OS‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) ‐2.0 [‐5.76, 1.76]
1.3 MOFS‐LE vs MS‐LE 1 58 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐2.58, 2.58]
1.4 MFS‐LE vs S‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) ‐1.0 [‐3.60, 1.60]
1.5 MFS‐LE vs MS‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) ‐2.0 [‐4.60, 0.60]
1.6 MFS‐LE vs OS‐LE 1 56 Mean Difference (IV, Fixed, 95% CI) ‐4.0 [‐7.78, ‐0.22]
2 Growth rate (g/kg/day) 5   Mean Difference (IV, Fixed, 95% CI) Subtotals only
2.1 MOFS‐LE vs S‐LE 5 347 Mean Difference (IV, Fixed, 95% CI) 0.71 [‐0.17, 1.60]
2.2 MOFS‐LE vs MS‐LE 1 58 Mean Difference (IV, Fixed, 95% CI) ‐0.33 [‐6.53, 5.87]
2.3 MOFS‐LE vs OS‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) ‐1.66 [‐7.91, 4.59]
2.4 MFS‐LE vs S‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) ‐1.67 [‐7.01, 3.67]
2.5 MFS‐LE vs MS‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) 1.0 [‐4.80, 6.80]
2.6 MFS‐LE vs OS‐LE 1 56 Mean Difference (IV, Fixed, 95% CI) ‐0.33 [‐6.18, 5.52]
3 Parenteral nutrition‐associated liver disease (PNALD)/cholestasis (conjugated bilirubin ≥ 2 mg/dL) 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
3.1 MOFS‐LE vs S‐LE 3 182 Risk Ratio (M‐H, Fixed, 95% CI) 0.56 [0.16, 1.99]
3.2 MOFS‐LE vs MS‐LE 2 118 Risk Ratio (M‐H, Fixed, 95% CI) 0.61 [0.15, 2.41]
3.3 MOFS‐LE vs OS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 3.10 [0.13, 73.12]
3.4 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 3.32 [0.14, 78.25]
3.5 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.11 [0.07, 16.91]
3.6 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 3.21 [0.14, 75.68]
4 PNALD/cholestasis (conjugated bilirubin ≥ 2 mg/dL): combined subgroups 4 328 Risk Ratio (M‐H, Fixed, 95% CI) 0.61 [0.24, 1.56]
5 PNALD/cholestasis (any definition) 11   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
5.1 MOFS‐LE vs S‐LE 8 800 Risk Ratio (M‐H, Fixed, 95% CI) 0.76 [0.49, 1.19]
5.2 MOFS‐LE vs MS‐LE 2 118 Risk Ratio (M‐H, Fixed, 95% CI) 0.61 [0.15, 2.41]
5.3 MOFS‐LE vs OS‐LE 2 135 Risk Ratio (M‐H, Fixed, 95% CI) 2.05 [0.48, 8.72]
5.4 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 3.32 [0.14, 78.25]
5.5 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.11 [0.07, 16.91]
5.6 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 3.21 [0.14, 75.68]
5.7 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.18 [0.05, 0.56]
6 PNALD/cholestasis (any definition): combined subgroups (all studies) and sensitivity analysis 11 1154 Risk Ratio (M‐H, Fixed, 95% CI) 0.63 [0.43, 0.91]
6.1 Low or unclear risk of bias studies 10 1024 Risk Ratio (M‐H, Fixed, 95% CI) 0.80 [0.53, 1.21]
6.2 High risk of bias studies 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.18 [0.05, 0.56]
7 Death before discharge 13   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
7.1 MOFS‐LE vs S‐LE 9 855 Risk Ratio (M‐H, Fixed, 95% CI) 1.24 [0.81, 1.90]
7.2 MOFS‐LE vs MS‐LE 2 120 Risk Ratio (M‐H, Fixed, 95% CI) 1.4 [0.28, 6.89]
7.3 MOFS‐LE vs OS‐LE 3 184 Risk Ratio (M‐H, Fixed, 95% CI) 1.19 [0.48, 2.93]
7.4 MFS‐LE vs S‐LE 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 5.0 [0.25, 99.95]
7.5 MFS‐LE vs MS‐LE 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 5.0 [0.25, 99.95]
7.6 MFS‐LE vs OS‐LE 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 5.0 [0.25, 99.95]
7.7 OFS‐LE vs OS‐LE 1 175 Risk Ratio (M‐H, Fixed, 95% CI) 1.12 [0.64, 1.97]
8 Any ROP 8 791 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.79, 1.11]
8.1 MOFS vs S‐LE 5 523 Risk Ratio (M‐H, Fixed, 95% CI) 0.92 [0.72, 1.17]
8.2 MOFS‐LE vs MS‐LE 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 0.86 [0.33, 2.25]
8.3 MOFS‐LE vs OS‐LE 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.06 [0.84, 1.35]
8.4 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.85 [0.53, 1.38]
9 Retinopathy of prematurity (ROP) (≥ stage 3) or requiring surgery 7 731 Risk Ratio (M‐H, Fixed, 95% CI) 0.80 [0.55, 1.16]
9.1 MOFS‐LE vs S‐LE 5 523 Risk Ratio (M‐H, Fixed, 95% CI) 0.82 [0.40, 1.68]
9.2 MOFS‐LE vs OS‐LE 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.25 [0.72, 2.18]
9.3 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.48 [0.24, 0.96]
10 ROP (≥ stage 3) or requiring surgery (sensitivity analysis) 6 601 Risk Ratio (M‐H, Fixed, 95% CI) 1.02 [0.65, 1.60]
10.1 MOFS‐LE vs S‐LE 5 523 Risk Ratio (M‐H, Fixed, 95% CI) 0.82 [0.40, 1.68]
10.2 MOFS‐LE vs OS‐LE 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.25 [0.72, 2.18]
11 Any bronchopulmonary dysplasia (BPD) 11   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
11.1 MOFS‐LE vs S‐LE 7 632 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.71, 1.22]
11.2 MOFS‐LE vs MS‐LE (1) 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 0.36 [0.13, 1.01]
11.3 MOFS‐LE vs MS‐LE (2) 1 58 Risk Ratio (M‐H, Fixed, 95% CI) 1.61 [0.51, 5.10]
11.4 MOFS‐LE vs OS‐LE 3 169 Risk Ratio (M‐H, Fixed, 95% CI) 1.17 [0.82, 1.67]
11.5 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.39 [0.42, 4.65]
11.6 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.39 [0.42, 4.65]
11.7 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 1.07 [0.35, 3.30]
11.8 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.86 [0.47, 1.56]
12 Chronic lung disease (oxygen requirement at 36 weeks) 9   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
12.1 MOFS‐LE vs S‐LE 6 581 Risk Ratio (M‐H, Fixed, 95% CI) 1.00 [0.75, 1.34]
12.2 MOFS‐LE vs MS‐LE (1) 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.10, 1.11]
12.3 MOFS‐LE vs MS‐LE (2) 1 58 Risk Ratio (M‐H, Fixed, 95% CI) 1.61 [0.51, 5.10]
12.4 MOFS‐LE vs OS‐LE 2 135 Risk Ratio (M‐H, Fixed, 95% CI) 1.18 [0.78, 1.81]
12.5 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.39 [0.42, 4.65]
12.6 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.39 [0.42, 4.65]
12.7 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 1.07 [0.35, 3.30]
12.8 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.86 [0.47, 1.56]
13 Duration of ventilation (days) 6   Mean Difference (IV, Fixed, 95% CI) Subtotals only
13.1 MOFS‐LE vs S‐LE 5 475 Mean Difference (IV, Fixed, 95% CI) 0.08 [‐1.56, 1.73]
13.2 MOFS‐LE vs MS‐LE 1 60 Mean Difference (IV, Fixed, 95% CI) ‐7.40 [‐10.26, ‐4.54]
14 Duration of supplemental oxygen (days) 3   Mean Difference (IV, Fixed, 95% CI) Subtotals only
14.1 MOFS‐LE vs S‐LE 2 140 Mean Difference (IV, Fixed, 95% CI) 0.47 [‐2.01, 2.95]
14.2 MOFS‐LE vs MS‐LE 1 60 Mean Difference (IV, Fixed, 95% CI) ‐13.80 [‐21.18, ‐6.42]
15 Duration of hospital stay (days) 8 812 Mean Difference (IV, Fixed, 95% CI) ‐0.48 [‐3.42, 2.46]
15.1 MOFS‐LE vs S‐LE 6 622 Mean Difference (IV, Fixed, 95% CI) ‐0.09 [‐3.35, 3.16]
15.2 MOFS‐LE vs MS‐LE 1 60 Mean Difference (IV, Fixed, 95% CI) ‐3.35 [‐17.13, 10.43]
15.3 OFS‐LE vs OS‐LE 1 130 Mean Difference (IV, Fixed, 95% CI) ‐1.80 [‐9.72, 6.12]
16 Culture‐positive sepsis 7 774 Risk Ratio (M‐H, Fixed, 95% CI) 1.16 [0.91, 1.48]
16.1 MOFS‐LE vs S‐LE 5 566 Risk Ratio (M‐H, Fixed, 95% CI) 1.02 [0.74, 1.40]
16.2 MOFS‐LE vs OS‐LE 1 78 Risk Ratio (M‐H, Fixed, 95% CI) 1.56 [0.86, 2.83]
16.3 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 1.35 [0.81, 2.24]
17 Any sepsis (clinical or culture positive (or both)) 12   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
17.1 MOFS‐LE vs S‐LE 9 832 Risk Ratio (M‐H, Fixed, 95% CI) 0.99 [0.78, 1.26]
17.2 MOFS‐LE vs MS‐LE 2 118 Risk Ratio (M‐H, Fixed, 95% CI) 0.80 [0.39, 1.67]
17.3 MOFS‐LE vs OS‐LE 2 135 Risk Ratio (M‐H, Fixed, 95% CI) 1.62 [0.96, 2.75]
17.4 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 1.11 [0.31, 4.02]
17.5 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 0.56 [0.19, 1.64]
17.6 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 1.07 [0.30, 3.87]
17.7 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 1.35 [0.81, 2.24]
18 Necrotising enterocolitis (≥ stage 2) 10   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
18.1 MOFS‐LE vs S‐LE 7 749 Risk Ratio (M‐H, Fixed, 95% CI) 1.32 [0.81, 2.13]
18.2 MOFS‐LE vs MS‐LE 2 118 Risk Ratio (M‐H, Fixed, 95% CI) 0.45 [0.07, 2.91]
18.3 MOFS‐LE vs OS‐LE 2 135 Risk Ratio (M‐H, Fixed, 95% CI) 2.37 [0.47, 11.99]
18.4 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
18.5 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 0.22 [0.01, 4.42]
18.6 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 0.36 [0.02, 8.41]
18.7 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.78 [0.23, 2.63]
19 Intraventricular haemorrhage (grade III‐IV) 7 617 Risk Ratio (M‐H, Fixed, 95% CI) 1.05 [0.65, 1.72]
19.1 MOFS‐LE vs S‐LE 5 523 Risk Ratio (M‐H, Fixed, 95% CI) 1.19 [0.71, 1.99]
19.2 MOFS‐LE vs OS‐LE 1 34 Risk Ratio (M‐H, Fixed, 95% CI) 0.2 [0.01, 3.88]
19.3 MOFS‐LE vs MS‐LE 1 60 Risk Ratio (M‐H, Fixed, 95% CI) 0.5 [0.05, 5.22]
20 Periventricular leukomalacia 3 399 Risk Ratio (M‐H, Fixed, 95% CI) 0.77 [0.18, 3.36]
20.1 MOFS‐LE vs S‐LE 3 399 Risk Ratio (M‐H, Fixed, 95% CI) 0.77 [0.18, 3.36]
21 Any patent ductus arteriosus 8   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
21.1 MOFS‐LE vs S‐LE 5 501 Risk Ratio (M‐H, Fixed, 95% CI) 0.91 [0.77, 1.09]
21.2 MOFS‐LE vs MS‐LE 1 58 Risk Ratio (M‐H, Fixed, 95% CI) 0.82 [0.49, 1.36]
21.3 MOFS‐LE vs OS‐LE 3 169 Risk Ratio (M‐H, Fixed, 95% CI) 0.84 [0.66, 1.09]
21.4 MFS‐LE vs S‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 0.96 [0.57, 1.64]
21.5 MFS‐LE vs MS‐LE 1 57 Risk Ratio (M‐H, Fixed, 95% CI) 0.85 [0.51, 1.40]
21.6 MFS‐LE vs OS‐LE 1 56 Risk Ratio (M‐H, Fixed, 95% CI) 0.93 [0.55, 1.58]
21.7 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.62, 1.66]
22 Significant patent ductus arteriosus requiring treatment 6 605 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.76, 1.04]
22.1 MOFS‐LE vs S‐LE 3 363 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.73, 1.08]
22.2 MOFS‐LE vs OS‐LE 2 112 Risk Ratio (M‐H, Fixed, 95% CI) 0.82 [0.62, 1.09]
22.3 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.62, 1.66]
23 Duration of phototherapy (days) 1 32 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐2.57, 2.57]
23.1 MOFS‐LE vs S‐LE 1 32 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐2.57, 2.57]
24 Hypertriglyceridaemia 5 697 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.80, 1.28]
24.1 MOFS‐LE vs S‐LE 4 567 Risk Ratio (M‐H, Fixed, 95% CI) 1.03 [0.81, 1.30]
24.2 OFS‐LE vs OS‐LE 1 130 Risk Ratio (M‐H, Fixed, 95% CI) 0.7 [0.17, 2.81]
25 Hyperglycaemia 3 280 Risk Ratio (M‐H, Fixed, 95% CI) 1.40 [0.77, 2.53]
25.1 MOFS‐LE vs S‐LE 3 280 Risk Ratio (M‐H, Fixed, 95% CI) 1.40 [0.77, 2.53]
26 Hypoglycaemia 2 248 Risk Ratio (M‐H, Fixed, 95% CI) 1.14 [0.77, 1.69]
26.1 MOFS‐LE vs S‐LE 2 248 Risk Ratio (M‐H, Fixed, 95% CI) 1.14 [0.77, 1.69]
27 Head growth velocity (cm/week) 2   Mean Difference (IV, Fixed, 95% CI) Subtotals only
27.1 MOFS‐LE vs S‐LE 2 140 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐0.08, 0.08]
28 Length velocity (cm/week) 1 44 Mean Difference (IV, Fixed, 95% CI) 0.10 [‐0.02, 0.22]
28.1 MOFS‐LE vs S‐LE 1 44 Mean Difference (IV, Fixed, 95% CI) 0.10 [‐0.02, 0.22]
29 Intrahepatocellular lipid 1 132 Mean Difference (IV, Fixed, 95% CI) 0.03 [‐0.17, 0.23]
29.1 MOFS‐LE vs S‐LE 1 132 Mean Difference (IV, Fixed, 95% CI) 0.03 [‐0.17, 0.23]
30 Non‐adipose tissue mass 1 133 Mean Difference (IV, Fixed, 95% CI) 24.20 [‐133.14, 181.54]
31 Conjugated bilirubin levels (µmol/L) 10   Mean Difference (IV, Fixed, 95% CI) Subtotals only
31.1 MOFS‐LE vs S‐LE 8 673 Mean Difference (IV, Fixed, 95% CI) ‐0.48 [‐1.16, 0.19]
31.2 MOFS‐LE vs MS‐LE 1 58 Mean Difference (IV, Fixed, 95% CI) 0.35 [‐3.65, 4.35]
31.3 MOFS‐LE vs OS‐LE 2 91 Mean Difference (IV, Fixed, 95% CI) ‐1.68 [‐4.07, 0.71]
31.4 MFS‐LE vs S‐LE 1 57 Mean Difference (IV, Fixed, 95% CI) 0.72 [‐3.86, 5.30]
31.5 MFS‐LE vs MS‐LE 2 105 Mean Difference (IV, Fixed, 95% CI) 2.15 [‐0.67, 4.98]
31.6 MFS‐LE vs OS‐LE 1 56 Mean Difference (IV, Fixed, 95% CI) ‐1.16 [‐6.13, 3.81]