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Fish oil–containing emulsions (e.g., SMOF) provide omega-3 fatty acids, reduce inflammation, and protect against PN-associated cholestasis. Soybean oil emulsions are pro-inflammatory and linked to PNALD. MCT-only emulsions are incomplete, and olive oil lacks omega-3s. Mixed emulsions are increasingly standard in neonatal PN.

Vitamin A is required for retinal function and epithelial integrity. Deficiency leads to night blindness, xerophthalmia, keratomalacia, and increased infection risk. PN patients without fat-soluble vitamin supplementation are at risk. Vitamin D deficiency causes bone disease, vitamin E deficiency causes hemolysis and neuropathy, and vitamin K deficiency causes coagulopathy.