Discussion
bone disease, hypertriglyceridemia, ROP, BPD
BONE DISEASE, DISORDER, MINERALIZATION, INTESTINAL INFLAMMATION, SECONDARY, HYPERTRIGLYCERIDEMIA, OXIDATIVE STRESS, COMPLICATIONS
ω-6 and ω-3 LCPUFAs are essential fatty acids and important components of the cell membrane. ω-6 LCPUFAs, represented by linoleic acid, γ-linoleic acid, and arachidonic acid (ARA), have been shown to increase the levels of pro-inflammatory cytokines and decrease oxidative stress injury [The univariate analysis revealed that compared with the MCT/LCT group, the proportion of TB＞5 mg/dL (84/231 [36.4%] vs. 60/234 [25.6%], Preterm infants are at a higher risk for hypertriglyceridemia than term neonates due to the lack of adequate muscle and fat reserves, which accounts for a reduced hydrolytic capacity of the lipoprotein lipase enzyme [MBDP is a kind of systemic bone disease caused by the deficiency of calcium, phosphorus, and matrix Gla protein (MGP). It is also known as the disorder of bone mentalism in premature infants, characterized by the decreased bone mineral content and incomplete mineralization of osteoid [It remains controversial whether SMOF is superior to other complications of premature infants. Persistent oxidative stress and inflammatory are common key factors leading to BPD, ROP, LOS and other complications of premature infants. SMOF contains an optimal ratio of ω-6/ω-3 LCPUFAs (2.5:1); in addition, it is rich in α-tocopherol, which has anti-inflammatory, antioxidation, and immune-regulatory effects. Animal models showed that ω-3 LCPUFAs in fish oil could reduce intestinal inflammation and improve the systemic immune response by regulating the intestinal flora [According to the literature review, this study is the largest prospective multicenter randomized controlled study comparing MCT/LCT and SMOF, with large sample size and reliable data. Since the five centers are distributed in 5 different provinces of China, their treatment populations may be reprensentative. It provides reliable evidence for optimizing the application of PN in premature infants. However, the study has certain limitations. Firstly, the study lacked a double-blind design because the consideration is that the use of intravenous fat emulsion should be adjusted according to the blood index of neonates to ensure medical safety. Secondly, the analysis of MBDP did not consider the dose and administration mode of Ca, P, and vitamin D supplementation between the two groups. In addition, MBDP was a secondary outcome and the sample size was not calculated to evaluate differences in incidence of MBDP, which needs further research to confirm. Thirdly, the PN protocol used in this study does not follow the ESPGHAN/ESPEN/ESPR/CSPEN 2018 guidelines, which may limit the generalizability of the study’s findings. Previous studies have demonstrated that SMOF can improve the long-term neurocognitive function of preterm infants [