[Indications for lipid infusion in pediatric patients]

The indication for the i.v. application of fat can be for energetic as well as structural reasons. In immature infants without sufficient fat stores there is a constant requirement for polyunsaturated long chain fatty acids of the omega-6- and omega-3-families for the formation of central nervous structures. There is increasing consciousness to consider fatty acids as precursors of bioactive mediators (eicosanoids). This leads to the concept to directly modify eicosanoid synthesis by means of the application of selected fatty acid families for to influence pathophysiologic events, for instance the mediation of inflammatory reactions. In case of an existing indication for the i.v. fat administration the metabolic tolerance has to be controlled, using serum triglyceride, free fatty acid and glucose determinations. The necessary ideas forming the basis of decision making are summarized and interrelated in a flow diagram.