Download PDF
Am J Perinatol 2021; 38(S 01): e92-e101
DOI: 10.1055/s-0040-1705174
Original Article

An Evaluation to Establish the Acceptable Serum Triglyceride Levels in Neonates Receiving Intravenous Fat Emulsion Infusion in a Multicenter Retrospective Study

Belinda Chan
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Anh Lian
2   Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah
,
Vickie Baer
3   Women and Newborn Research, Intermountain Healthcare, Salt Lake City, Utah
,
Mandy Robinson
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
,
Zhining Ou
4   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
,
Angela P. Presson
4   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
,
Erin K. Zinkhan 
1   Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
› Author Affiliations Funding This investigation was supported by the University of Utah Population Health Research Foundation (A.P.P. and Z.O.), with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105, and UL1RR025764).
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to establish neonatal serum triglyceride (TG) level reference ranges during lipid infusion and correlate peak TG with neonatal outcomes.

Study Design This is a retrospective review of 356 neonates with 696 TG measures obtained in four neonatal intensive care units between 2015 and 2017. TG was evaluated collectively to establish a reference range and a threshold limit. To analyze the effects of a higher TG threshold, neonates were categorized by their peak TG: <180 (TG<180), 180 to 400 (TG180–400), and > 400 mg/dL (TG>400). Univariable and multivariable regression models were constructed to compare peak TG to patient characteristic and clinical outcomes.

Results The frequency of TG > 400 mg/dL was 5% and found only in neonates weighing < 1.5 kg. Neonates in the TG180–400 (n = 91) group were significantly lower in birth weight and gestational age, had lower 5-minute APGAR scores, and had increased ventilatory requirement when compared with neonates in the TG<180 (n = 240) group (all p < 0.001). The TG180–400 group had increased risk of severe intraventricular hemorrhage (p = 0.02) and bronchopulmonary dysplasia (p = 0.03). Elevated TG was associated with mortality (odds ratio [OR]: 14.4, p < 0.001) in univariable analysis, but the relationship weakened (OR: 4.4, p = 0.05) after adjusting for comorbidities in multivariable logistic regression.

Conclusion It is unclear if the adverse outcomes seen in neonates with higher peak TG were due to elevated TG alone, or whether illness severity predicted the increased TG. More prospective studies are needed to further delineate the relationships.

Keywords

triglyceride - intravenous fat emulsion infusion - Intralipid - fatty acids - total parenteral nutrition - neonate - preterm - infants

Supplementary Material



Publication History

Received: 11 September 2019

Accepted: 29 January 2020

Article published online:
02 March 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lapillonne A, Groh-Wargo S, Gonzalez CH, Uauy R. Lipid needs of preterm infants: updated recommendations. J Pediatr 2013; 162 (3, Suppl): S37-S47
    CrossrefPubMedGoogle Scholar
  • 2 Robinson DT, Martin CR. Fatty acid requirements for the preterm infant. Semin Fetal Neonatal Med 2017; 22 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 3 Salama GS, Kaabneh MA, Almasaeed MN, Alquran MIa. Intravenous lipids for preterm infants: a review. Clin Med Insights Pediatr 2015; 9: 25-36
    CrossrefPubMedGoogle Scholar
  • 4 Kerner Jr JA, Poole RL. The use of IV fat in neonates. Nutr Clin Pract 2006; 21 (04) 374-380
    CrossrefPubMedGoogle Scholar
  • 5 Raman M, Almutairdi A, Mulesa L, Alberda C, Beattie C, Gramlich L. Parenteral nutrition and lipids. Nutrients 2017; 9 (04) 388
    CrossrefPubMedGoogle Scholar
  • 6 Mirtallo J, Canada T, Johnson D. et al; Task Force for the Revision of Safe Practices for Parenteral Nutrition. Safe practices for parenteral nutrition. JPEN J Parenter Enteral Nutr 2004; 28 (06) S39-S70
    CrossrefPubMedGoogle Scholar
  • 7 Lapillonne A, Fidler Mis N, Goulet O, van den Akker CHP, Wu J, Koletzko B. ; ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: lipids. Clin Nutr 2018; 37 (6 Pt B): 2324-2336
    CrossrefPubMedGoogle Scholar
  • 8 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedGoogle Scholar
  • 9 Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007; 165 (06) 710-718
    CrossrefPubMedGoogle Scholar
  • 10 R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Accessed September 2019 at: https://www.R-project.org
  • 11 Marshall WJ. The interpretation of biochemical data. In: Marshall WJ, Bangert SK. eds. Clinical Biochemistry: Metabolic and Clinical Aspects. Philadelphia: Churchill Livingstone/Elsevier; 2008: 19
    Google Scholar
  • 12 Decsi T, Molnár D, Klujber L. Lipid levels in very low birthweight preterm infants. Acta Paediatr Scand 1990; 79 (6-7): 577-580
    CrossrefPubMedGoogle Scholar
  • 13 Kao LC, Cheng MH, Warburton D. Triglycerides, free fatty acids, free fatty acids/albumin molar ratio, and cholesterol levels in serum of neonates receiving long-term lipid infusions: controlled trial of continuous and intermittent regimens. J Pediatr 1984; 104 (03) 429-435
    CrossrefPubMedGoogle Scholar
  • 14 Fenton TR, Singhal N, Baynton RD, Akierman A. Serum triglycerides of breast milk-fed very-low-birth-weight infants. Nutr Clin Pract 1997; 12 (01) 26-29
    CrossrefPubMedGoogle Scholar
  • 15 Greer FR, McCormick A, Kashyap ML, Glueck CJ. Late hypertriglyceridemia in very low birth weight infants fed human milk exclusively. J Pediatr 1987; 111 (03) 466-469
    CrossrefPubMedGoogle Scholar
  • 16 Hegyi T, Kleinfeld A, Huber A. et al. Effects of soybean lipid infusion on unbound free fatty acids and unbound bilirubin in preterm infants. J Pediatr 2017; 184: 45-50.e1
    CrossrefPubMedGoogle Scholar
  • 17 Brans YW, Andrew DS, Carrillo DW, Dutton EB, Menchaca EM, Puelo-Scheppke BA. Tolerance of fat emulsions in very low birthweight neonates: effect of birthweight on plasma lipid concentrations. Am J Perinatol 1990; 7 (02) 114-117
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Choi YJ, Bae HJ, Lee JY. et al. Analysis of risk factors for lipid intolerance of intravenous fat emulsion in very low birth weight infants. Arch Pharm Res 2015; 38 (05) 914-920
    CrossrefPubMedGoogle Scholar
  • 19 Sinclair R, Schindler T, Lui K, Bolisetty S. Hypertriglyceridaemia in extremely preterm infants receiving parenteral lipid emulsions. BMC Pediatr 2018; 18 (01) 348
    CrossrefPubMedGoogle Scholar
  • 20 Freeman J, Goldmann DA, Smith NE, Sidebottom DG, Epstein MF, Platt R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med 1990; 323 (05) 301-308
    CrossrefPubMedGoogle Scholar
  • 21 Vlaardingerbroek H, Veldhorst MA, Spronk S, van den Akker CH, van Goudoever JB. Parenteral lipid administration to very-low-birth-weight infants--early introduction of lipids and use of new lipid emulsions: a systematic review and meta-analysis. Am J Clin Nutr 2012; 96 (02) 255-268
    CrossrefPubMedGoogle Scholar
  • 22 Pontes-Arruda A, Liu FX, Turpin RS, Mercaldi CJ, Hise M, Zaloga G. Bloodstream infections in patients receiving manufactured parenteral nutrition with vs without lipids: is the use of lipids really deleterious?. JPEN J Parenter Enteral Nutr 2012; 36 (04) 421-430
    CrossrefPubMedGoogle Scholar
  • 23 Choudhary N, Tan K, Malhotra A. Inpatient outcomes of preterm infants receiving ω-3 enriched lipid emulsion (SMOFlipid): an observational study. Eur J Pediatr 2018; 177 (05) 723-731
    CrossrefPubMedGoogle Scholar
  • 24 Puntis JW, Rushton DI. Pulmonary intravascular lipid in neonatal necropsy specimens. Arch Dis Child 1991; 66 (1 Spec No): 26-28
    CrossrefPubMedGoogle Scholar
  • 25 The United States Pharmacopeial Convention. Globule size distribution in lipid injectable emulsions. Rockville, MD: The United States pharmacopeia.; 2007 ;(729): 3968-3970
    Google Scholar
  • 26 Brans YW, Dutton EB, Andrew DS, Menchaca EM, West DL. Fat emulsion tolerance in very low birth weight neonates: effect on diffusion of oxygen in the lungs and on blood pH. Pediatrics 1986; 78 (01) 79-84
    CrossrefPubMedGoogle Scholar
  • 27 Martin CR, Dasilva DA, Cluette-Brown JE. et al. Decreased postnatal docosahexaenoic and arachidonic acid blood levels in premature infants are associated with neonatal morbidities. J Pediatr 2011; 159 (05) 743-749.e1 , 2
    CrossrefPubMedGoogle Scholar
  • 28 Prasertsom W, Phillipos EZ, Van Aerde JE, Robertson M. Pulmonary vascular resistance during lipid infusion in neonates. Arch Dis Child Fetal Neonatal Ed 1996; 74 (02) F95-F98
    CrossrefPubMedGoogle Scholar
  • 29 Kessler U, Zachariou Z, Raz D, Poeschl J, Linderkamp O. Effects of Intralipid infusion on hemorheology and peripheral resistance in neonates and children. Pediatr Surg Int 2005; 21 (03) 197-202
    CrossrefPubMedGoogle Scholar
  • 30 Barrington KJ, Finer N, Pennaforte T. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev 2017; 1: CD000509
    PubMedGoogle Scholar
  • 31 Gregory K. Update on nutrition for preterm and full-term infants. J Obstet Gynecol Neonatal Nurs 2005; 34 (01) 98-108
    CrossrefPubMedGoogle Scholar
  • 32 Brandt I, Sticker EJ, Lentze MJ. Catch-up growth of head circumference of very low birth weight, small for gestational age preterm infants and mental development to adulthood. J Pediatr 2003; 142 (05) 463-468
    CrossrefPubMedGoogle Scholar
  • 33 Tan MJ, Cooke RW. Improving head growth in very preterm infants--a randomised controlled trial I: neonatal outcomes. Arch Dis Child Fetal Neonatal Ed 2008; 93 (05) F337-F341
    CrossrefPubMedGoogle Scholar
  • 34 Schneider J, Fischer Fumeaux CJ, Duerden EG. et al. Nutrient intake in the first two weeks of life and brain growth in preterm neonates. Pediatrics 2018; 141 (03) e20172169
    CrossrefPubMedGoogle Scholar
  • 35 Sáenz de Pipaón M, Closa R, Gormaz M. et al. Nutritional practices in very low birth weight infants: a national survey. Nutr Hosp 2017; 34 (05) 1067-1072
    PubMedGoogle Scholar
  • 36 Drenckpohl D, McConnell C, Gaffney S, Niehaus M, Macwan KS. Randomized trial of very low birth weight infants receiving higher rates of infusion of intravenous fat emulsions during the first week of life. Pediatrics 2008; 122 (04) 743-751
    CrossrefPubMedGoogle Scholar
  • 37 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
    CrossrefPubMedGoogle Scholar
  • 38 Dawson NV, Weiss R. Dichotomizing continuous variables in statistical analysis: a practice to avoid. Med Decis Making 2012; 32 (02) 225-226
    CrossrefPubMedGoogle Scholar