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Intravenous lipid and bilirubin-albumin binding variables in premature infants
Sanjiv B Amin1, Theresa Harte, Lori Scholer
1Division of Neonatology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York 14642, USA. sanjiv_amin@urmc.rochester.edu
Insights
Increased lipid emulsion (IL) intake can decrease bilirubin binding in premature infants. This effect is more pronounced in infants younger than 28 weeks gestational age, highlighting the importance of GA in managing hyperbilirubinemia.
Area of Science:
- Neonatalogy
- Clinical Chemistry
- Pharmacology
Background:
- The threshold for lipid emulsion (IL) intake affecting bilirubin-albumin binding in premature infants is not well-defined.
- Indirect hyperbilirubinemia is a common concern in preterm neonates.
Purpose of the Study:
- To investigate the impact of escalating Intralipid (IL) doses (1.5 to 3 g/kg/day) on bilirubin-albumin binding in premature infants.
- To assess how gestational age (GA) influences the relationship between IL intake and bilirubin binding variables.
Main Methods:
- Prospective evaluation of 62 infants (24-33 weeks GA) receiving incremental IL doses over 4 days.
- Measurement of total and free bilirubin, and albumin to calculate binding affinity.
- Analysis of free bilirubin concentration relative to GA and IL intake.
Main Results:
- Higher IL intake was associated with decreased binding affinity and increased free bilirubin in infants <=28 weeks GA.
- This effect was not observed in infants >28 weeks GA.
- Elevated free bilirubin concentration showed an inverse relationship with GA.
Conclusions:
- Intralipid intake can significantly reduce bilirubin's binding affinity to plasma proteins, increasing free bilirubin levels in preterm infants.
- The critical IL intake level for this effect is dependent on the infant's gestational age.
Background:
The lipid intake at which a significant bilirubin-displacing effect occurs as a function of gestational age (GA) is unclear.
Objective:
To determine the effect of gradual increase in IL intake from 1.5 to 3 g/kg per day on bilirubin-albumin binding variables as a function of GA in premature infants with indirect hyperbilirubinemia.
Methods:
Infants of 24 to 33 weeks' gestation at birth who received IL (20% Intralipid [Fresenius Kabi, Uppsala, Sweden]) doses of 1.5, 2, 2.5, and 3 g/kg per day over 4 consecutive days were prospectively evaluated. The blood samples were drawn twice at least 8 hours apart on each IL intake to measure total serum bilirubin and free bilirubin by the peroxidase test. The highest free bilirubin on each IL intake, the corresponding total serum bilirubin, and serum albumin were used to calculate the bilirubin/albumin binding constant or binding affinity.
Results:
Sixty-two infants (median GA: 28 weeks) were studied during the first 10 days of life. None of the subjects had culture-proven sepsis, had triglyceride levels of >2.05 mmol/L, or were receiving steroids. Infants were grouped in 2-week GA intervals. The cumulative frequency of elevated free bilirubin concentration (>or=90th percentile or B(f) >or= 32 nmol/L) as a function of IL intake was inversely related to GA and was significantly different among 2-week GA groups. There was significant decrease in binding affinity and increase in free bilirubin concentration with higher IL intake for
Conclusions:
The IL intake may be associated with a significant fall in the binding affinity of bilirubin for plasma protein and a concomitant increase in free bilirubin concentration in premature infants. The lipid intake at which this occurs depends on GA.
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