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Comparison of different intravenous lipid emulsion formulations used in infants and children

Comparison of different intravenous lipid emulsion formulations used in infants and children
  Intralipid
(Fresenius Kabi)		 Nutrilipid
(B. Braun)		 Omegaven*
(Fresenius Kabi)		 Smoflipid
(Fresenius Kabi)		 Clinolipid/ClinOleic
(Baxter)
Concentrations (percent) 10, 20 20 10 20 20
Oil source (percent) Soybean 100 Soybean 100 Fish 100

Soybean 30

MCT 30

Olive 25

Fish 15

Olive 80

Soy 20
Fatty acids (percent)Δ
Linoleic (C 18:2 ω-6) 44 to 62 48 to 58 1 to 7 18.7 13.8 to 22
Linolenic (C 18:3 ω-3) 4 to 11 4 to 11 2 2.4 0.5 to 4.2
Palmitic (C 16:0) 7 to 14 9 to 13 2.5 to 10 9.2 7.6 to 19.3
Oleic (C 18:1 ω-9) 19 to 30 17 to 30 6 to 13 27.8 44.3 to 79.5
Stearic (C 18:0) 1.4 to 5.5 2.5 to 5 0.5 to 2 2.7 0.7 to 5.0
EPA (C 20:5 ω-3) 0 0 12.5 to 28.2 2.4 0
DHA (C 22:6 ω-3) 0 0 14.4 to 30.9 2.2 0
Caprylic acid (C 8:0) 0 0 0 16.3 0
Caproic acid (C 10:0) 0 0 0 11.4 0
Ratio (ω-6:ω-3) 7:1 Not available 1:7 2.5:1 9:1
Egg yolk phospholipids (percent) 1.2 1.2 1.2 1.2 1.2
Glycerin (percent) 2.25, 2.25 2.5 2.5 2.5 2.25
Energy density (kcal/mL) 1.1, 2 2 1.1 2 2
Osmolarity

300, 350 mOsm/kg

260, 260 mOsm/L		 390 mOsm/kg

342 mOsm/kg

273 mOsm/L

380 mOsm/kg

270 mOsm/L

340 mOsm/kg

260 mOsm/L
For patients on prolonged exclusive parenteral nutrition, there is a risk of essential fatty acid deficiency, especially if the lipid dose is lower than recommended or with products with lower components of essential fatty acids (linoleic and linolenic). For preterm and very low birth weight infants, intravenous lipid emulsions have risks of hyperlipidemia, fat accumulation in lungs, and potential aluminum toxicity, as outlined in product labeling information. Refer to accompanying UpToDate topic text and local product information.

DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; MCT: medium-chain triglycerides; PUFA: long-chain n-3 polyunsaturated fatty acids.

* Omegaven fish oil contains several other n-3 PUFAs and arachidonic acid, in addition to those shown in this table. Additional information is available from the Oley Foundation website.

¶ This product is known as Clinolipid in the United States and ClinOleic in other countries.

Δ For fatty acids, the percentages shown are based on the lipid component of emulsion only. Thus, for a 10% lipid emulsion, the final concentration (ie, grams per 100 mL) is obtained by dividing each fatty acid percent shown in the table by 10. The chemical structure is noted as: length of hydrocarbon chain (C atoms): number of double bonds; and position of first double bond (ω).
Data from:
  1. Gura KM, Duggan CP, Collier SB, et al. Reversal of parenteral nutrition - associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management. Pediatrics 2006; 118:197.
  2. Nordenström J, Thörne A. Comparative studies on a new concentrated fat emulsion: intralipid 30 percent vs. 20 percent. Clin Nutr 1993; 12:160.
  3. Vanek VW, Seidner DL, Allen P, et al. A.S.P.E.N. position paper: Clinical role for alternative intravenous fat emulsions. Nutr Clin Pract 2012; 27:150.
  4. Smoflipid (lipid injectable emulsion) United States product information. May 2023. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/207648s010lbl.pdf (Accessed on April 29, 2024).
  5. Rayvan M, Devliger H, Jochum F, et al. Short-term use of parenteral nutrition with a lipid emulsion containing a mixture of soybean oil, olive oil, medium-chain triglycerides and fish oil: A randomized double-blind study in preterm infants. J Parenter Enteral Nutr 2012; 36:81S.
  6. Clinilipid (lipid injectable emulsion) United States product information. April 2024. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/204508s022lbl.pdf (Accessed on April 29, 2024).
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