Purpose: Very low birth weight infants (VLBWI) are found to have a higher incidence of cholestasis due to long-term total parenteral nutrition (TPN). Although there have been some studies on relationships between omega-3 fatty acids and reduced incidence of cholestasis, the advantages that the fatty acids provide for premature infant diseases have not yet been fully understood. The aim of this study was to evaluate the advantages of SMOFlipid, a lipid emulsion product that contains omega-3 over

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... other lipid emulsion products that do not. Methods: The medical records of 182 newborn (127 boys and 55 girls) were reviewed retrospectively between April 2010 and August 2012. These infants were born with a birth weight of <1,500 g and administered either of lipid emulsions (Intra MCT 20% or SMOFlipid) from birth to a full-feeding condition at our neonatal intensive care unit. Cholestasis is defined as serum direct bilirubin (DB) >1.0 mg/dL when total bilirubin (TB) is <5 mg/dL or DB/TB ratio is >20% when TB >5 mg/dL. Results: The incidence of cholestasis was found to be lower in the SMOFlipid group than in the medium-chain triglyceride/long chain triglyceride (MCT/LCT) group (7. 3% [4/55] versus 18.9% [24/127], P=0.046). At the start of lipid emulsion administration (day 0), the baseline bilirubin level showed no significant difference between the two groups. However, the maximum value of DB on days 7∼ 14 was lower in the SMOFlipid group than in the MCT/ LCT group (0.8 [0.3∼2.2] versus 1.1 [0.3∼2.8] mg/dL, P= 0.030). The DB/TB ratio was also lower in the SMOFlipid group than in the MCT/LCT group (10.2% [4.9%∼40.0%] versus 24.1% [5.1%∼62.5%], P=0.002). Conclusion: This study concluded that SMOFlipid was effective in the prevention of cholestasis in VLBWI. Therefore, omega-3-containing lipid emulsion can be highly recommended in premature babies, especially in VLBWI who require TPN support. (JKSPEN 2013;5(2):67-75) Key Words: Very low birth weight infant, Total parenteral nutrition, Cholestasis, Retinopathy of prematurity, Omega-3 fatty acids 중심 단어: 극소 저출생 체중아, 정맥영양, 담즙정체증, 미숙 아망막병증, 오메가-3 지방산 서 론 신생아 의학의 발전으로 생존 가능한 태아의 출생 체중 은 낮아지고 있으며, 신생아 괴사성 장염(necrotizing enterocolitis), 태변성 장폐쇄(meconium obstruction) 등과 같은 여 러 합병증이 증가함으로써 총정맥영양(total parenteral nutrition)을 필요로 하는 신생아가 증가하고 있다. 장기간의 정맥영양으로 인한 담즙정체증(cholestasis)의 발생은 경장 영양의 지연, 담즙분비 기능의 미성숙, 염증, 산화적 스트레 스, 감염, 영양 실조, 정맥영양 중의 불순물 등에서 기인하 는 것으로 알려졌다. 1 1,500 g 미만의 조산아의 경우 담즙분 비 기능이 미숙할 뿐만 아니라 위장관 기능도 미성숙하여 장기간의 정맥영양을 통한 영양공급이 불가피하므로 담즙 정체증의 발생률이 특히 높다. 1 또한 패혈증(sepsis)은 염증