Abstract / Summary
Abstract Background The association between parenteral lipid emulsion composition and retinopathy of prematurity (ROP) outcomes remains uncertain. We compared ROP outcomes and retinal vascularization between very low birth weight (VLBW) infants receiving soybean/MCT-based or fish oil-containing mixed lipid emulsions and explored anti-VEGF treatment and refractive outcomes. Methods We conducted a retrospective single-center cohort study of 278 VLBW infants (< 1500 g and < 31 weeks’ gestation) who received total parenteral nutrition between 2008 and 2019. Infants received either soybean/MCT-based lipid emulsions (Group 1; n = 158) or fish oil-containing mixed lipid emulsions (Group 2; n = 120). Primary outcomes were ROP incidence, ROP stage, and complete peripheral retinal vascularization. Postmenstrual age (PMA) at complete vascularization was reconstructed from the recorded PMA and interval to complete vascularization and analyzed using Kaplan–Meier methods. Secondary exploratory analyses included anti-VEGF treatment and refractive outcomes at one year of corrected age. Results ROP occurred in 69.0% of Group 1 and 78.3% of Group 2. The overall distribution of ROP stages differed between groups ( P = 0.005), although the proportion of stage 3 ROP was similar (36.7% vs. 33.3%, P = 0.560). The recorded interval to complete peripheral retinal vascularization was shorter in Group 2 (4.1 ± 1.6 vs. 4.7 ± 1.8 months, P = 0.007). Kaplan–Meier analysis also demonstrated earlier complete vascularization in Group 2, with median reconstructed PMA of 50.4 versus 52.4 weeks in Group 1 (log-rank P = 0.019). In multivariable analysis, lower gestational age and birth weight were independently associated with ROP development, whereas lipid emulsion type was not (OR = 1.237, 95% CI 0.664–2.305; P = 0.503). Exploratory analyses showed no significant difference in vascularization timing between bevacizumab and ranibizumab, and refractive outcomes were associated primarily with ROP stage rather than lipid emulsion type or anti-VEGF agent. Conclusions Fish oil-containing mixed lipid emulsion use was associated with earlier completion of peripheral retinal vascularization but not with a lower proportion of stage 3 ROP or independently with ROP development. These findings should be interpreted cautiously given the retrospective study design.