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Intestinal absorption of lipid emulsion in premature infants: a pilot study
A Janvier1, L Beaumier, K J Barrington
1Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
Insights
Enteral lipid emulsions can be safely given to very-low-birth-weight infants in the early neonatal period. This method of feeding ensures adequate nutrition with high fat absorption and no adverse clinical effects.
Area of Science:
- Neonatal Nutrition
- Gastroenterology
- Pediatric Intensive Care
Background:
- Achieving adequate nutritional intake is crucial for very-low-birth-weight (VLBW) infants during the initial postnatal days.
- Enteral feeding of lipid emulsions in sick preterm infants during the first few days of life presents challenges.
Purpose of the Study:
- To evaluate the tolerance and absorption of enteral lipid emulsions in very-low-birth-weight infants.
- To assess the safety and efficacy of early enteral lipid administration in preterm neonates.
Main Methods:
- A progressive study involving VLBW infants (<1,500 g) receiving parenteral nutrition.
- Infants were administered escalating doses of enteral lipid emulsion (1-3 g/kg/day) at different postnatal stages.
- Fat absorption was measured, and clinical adverse effects were monitored.
Main Results:
- Enteral lipid emulsion administration was initiated on day 2 in one group and day 8 in others.
- Intestinal lipid absorption averaged 93.6%, with no significant differences observed between groups.
- No adverse clinical findings were reported, except for one case of necrotizing enterocolitis unrelated to the study intervention.
Conclusions:
- Lipid emulsions can be safely administered enterally to VLBW infants in the early neonatal period, offering a high-calorie, isotonic nutritional source.
- Enteral lipid administration demonstrates high absorption rates and is well-tolerated, suggesting potential advantages over intravenous routes.
- Early oral administration of lipid emulsions warrants further investigation for optimizing neonatal nutrition.
Background:
Adequate nutritional intake is essential in the very-low-birth-weight infant, but difficult to achieve in the first few postnatal days. Can lipids be given enterally in the first few days of life in sick preterm infants?
Objective:
To determine tolerance and absorption of lipid emulsion when fed enterally to very-low-birth-weight infants.
Design/Methods:
Infants had a birth weight <1,500 g, an appropriate weight for gestational age, and were receiving parenteral nutrition. We performed a progressive series of studies, enrolling 5 infants in each group. Group 1 infants were fed enteral lipid emulsion at 1 g/kg/day for 4 days, starting when 60 ml/kg/day of breast milk was tolerated enterally. Simultaneously, a matched control group which received no oral lipid emulsion was enrolled. We then enrolled group 2 infants who were fed 3 g/kg/day with the same protocol as group 1. Group 3 infants were fed enteral lipid emulsion starting in the first 72 h of life. The infants were fed 1, 2 and 3 g/kg/day subsequently for 48 h each. Fat absorption was measured.
Results:
Gestational age was 24.6-30.8 weeks and birth weight was 620-1,400 g. One infant (group 1) developed necrotizing enterocolitis 1 week after the study. There were no other adverse clinical findings. On average, enteral lipid emulsion was started on day 8 of life in groups 1 and 2, and on day 2 in group 3. The intestinal lipid absorption was 93.6% (min. = 76%). There was no difference in fat absorption between the 4 groups (p > 0.05).
Conclusions:
Lipid emulsions are an isotonic high-calorie source which can be given safely enterally instead of intravenously in the immediate neonatal period of very-low-birth-weight infants without clinical adverse effects and with almost complete absorption. There are potential advantages to oral administration of a lipid emulsion starting in early life which require further investigation.
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