How Effect Olive Oil and Eoprotin on Immunological Parameters and Growth
How Effect Olive Oil and Eoprotin on Immunological Parameters and Growth
This study aims to compare immunologic parameters of 60 patients who are 1-28 days-aged,
 below 1500-gram body weight, born before 32 weeks of gestational age and fed with eoprotin or
 olive-oil fortified breast milk. Cases will receive same amount of calorie intake either with
 eoprotin or olive oil fortified-breast milk. If investigators identify that olive oil doesn't
 increase proinflammatory cytokines and grant enough weight gain in premature infants at the
 end of the study, investigators will suggest olive oil to replace eoprotin which is a very
 costly breast milk-fortifier.
Low birth weight infants are premature infants that born with birth weight less than 1500 g.
 Because these infants have low birth weight, weight gain can be increased by fortifying
 breast milk after post-natal 7. day. Breast milk fortifiers might be preferred for very low
 birth weight or extremely low birth weight infants (infants with <1000 g birth weight
 infants) for faster weight gain. It does not increase risk of necrotizing enterocolitis or
 infection; and it has lower incidences of necrotizing enterocolitis and sepsis comparing to
 formula. Breast milk is usually fortified with 100 cc/kg/day enteral feeding (1,2,3,4). Even
 though many centers use olive oil to fortify breast milk for many years; there is no study to
 evaluate its scientific value. Hence it has been known that olive oil based parenteral
 nutrition solutions are well-tolerated by premature infants, are immunologically more
 neutral, does not increase proinflammatory cytokines; olive oil is the only fat consumed in
 its natural form and has antimicrobial and cytotoxic effects, lowers serum cholesterol
 concentration by decreasing cholesterol absorption, has protective measures against
 cardiovascular diseases due to antioxidant effects of ingredients such as mono- and
 poly-unsaturated fatty acids, phenolic substances, tocopherols and carotenoids; olive oil has
 antioxidant, cell renewal and anti- carcinogenic features because of containing squalene
 which is precursor of steroid synthesis and help digestion by increasing digestive juice by
 major pigments such as chlorophyll, pheophytin and chlorophyll (5).

 In previous studies; it has been shown that nutritional support with parenteral olive oil
 emulsion has better plasma lipid content similarities to breast milk, lower proinflammatory
 cytokine synthesis, lower lipid peroxidation product levels, stronger T-cell response, higher
 E vitamin levels; and thus lower risk of nosocomial infections, SIRS (systemic inflammatory
 response syndrome), BPD (bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), PVL
 (periventricular leukomalacia), ROP (retinopathy of prematurity) and cardiovascular diseases
 and positive impact on glucose metabolism. Participants hypothesize that oral olive oil
 intake will have similar effects (6).

 Investigators aims to compare post-nutritional immunologic parameters of 1-28 day-aged 60
 infants with <1500 g birth weight and < 32 weeks of gestational age who were fed with
 maternal milk that is fortified with eoprotin and olive oil and diagnosed and followed-up in
 Neonatal Intensive Care Unit of Pediatrics Department of Medicine Faculty of Yüzüncü Yıl
 University.

 This study will be conducted on 60 patients who are 1-28 days-aged, below 1500-gram body
 weight, born before 32 weeks of gestational age and diagnosed and followed in Neonatal Unit
 of Pediatrics Department of Medicine Faculty of Yüzüncü Yıl University. For 45 days, 30
 patients will receive eoprotin as breast milk fortifier while another 30 patients will
 receive olive oil, then 3 cc of blood will be taken from all patients at 0, 15., 30. and 45.
 days into biochemistry vials and will be stored at -80 C after centrifuge. At the end of the
 study, vials will be thawed in room temperature and serum TNF-alpha, IL-1 Beta, IL-6, IL-8,
 IL-10 levels will be analyzed with ELISA method by BIO-Tec ELx800 Absorbance Reader device
 and lipid profiles (LDL, HDL, Total cholesterol and triglyceride) and levels will be analyzed
 with spectrophotometric method by Architect ci16200; then these parameters will be compared
 with each other.

 After feeding with olive oil infants will have received same amount of calorie with infants
 who will receive eoprotin-fortified breast milk. At the end of study, if participants
 identify that olive oil doesn't increase proinflammatory cytokines and provide enough weight
 gain in premature infants, investigators will suggest olive oil to replace eoprotin which is
 a very costly breast milk-fortifier. Investigators believe this situation will contribute to
 both country and family budgets.
Inclusion Criteria:

 -  Infants with <1500 g birth weight

 -  Infants with< 32 weeks of gestational age

 -  Infants who will be fed with maternal milk that is fortified with eoprotin and olive
 oil

 Exclusion Criteria:

 -  Critical ill patients

 -  Evident severe congenital malformation

 -  Intolerance of feeding

 -  Evident gastrointestinal malformation