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Intravenous lipids for preterm infants: a review
Ghassan Sa Salama1, Mahmmoud Af Kaabneh1, Mai N Almasaeed1
1Pediatric Department, Royal Medical Services, Amman, Jordan.
Insights
Parenteral nutrition is crucial for extremely low birth weight infants. This review clarifies the science behind intravenous lipid use, challenging traditional beliefs and promoting evidence-based care for critically ill neonates.
Area of Science:
- Neonatal nutrition
- Pediatric critical care
- Lipid metabolism
Background:
- Extremely low birth weight (ELBW) infants require intensive care and nutritional support due to rapid growth needs and inability to feed enterally.
- Current practices show reluctance in using early intravenous lipids for ELBW infants, often based on unsubstantiated concerns.
- Existing literature lacks a comprehensive review on intravenous lipid use specifically for very low birth weight and critically ill neonates.
Purpose of the Study:
- To provide a comprehensive overview of lipid biochemistry and metabolism relevant to preterm infants.
- To examine the origins of current clinical practices and dogmas surrounding intravenous lipid administration.
- To review existing literature to inform evidence-based revisions in clinical care for intravenous lipid use in neonates.
Main Methods:
- Review of lipid biochemistry and metabolism in the context of preterm infant physiology.
- Analysis of historical and current clinical practices regarding intravenous lipid use.
- Comprehensive literature review of studies on intravenous lipids in neonates.
Main Results:
- Discussion of lipid biochemistry and metabolism tailored to preterm infants.
- Exploration of the scientific basis (or lack thereof) for common concerns about intravenous lipids (e.g., lung disease, sepsis, CNS injury).
- Synthesis of current evidence to address controversies and guide clinical decision-making.
Conclusions:
- Clinical care regarding intravenous lipids in ELBW infants is often based on tradition rather than scientific evidence.
- A comprehensive understanding of lipid metabolism and a review of the literature are needed to revise current practices.
- This review aims to provide clarity and support evidence-based guidelines for optimizing nutritional support in critically ill neonates.
Abstract:
Extremely low birth weight infants (ELBW) are born at a time when the fetus is undergoing rapid intrauterine brain and body growth. Continuation of this growth in the first several weeks postnatally during the time these infants are on ventilator support and receiving critical care is often a challenge. These infants are usually highly stressed and at risk for catabolism. Parenteral nutrition is needed in these infants because most cannot meet the majority of their nutritional needs using the enteral route. Despite adoption of a more aggressive approach with amino acid infusions, there still appears to be a reluctance to use early intravenous lipids. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, displace bilirubin from albumin, exacerbate sepsis, and cause CNS injury and thrombocytopena. Several recent reviews have focused on intravenous nutrition for premature neonate, but very little exists that provides a comprehensive review of intravenous lipid for very low birth and other critically ill neonates. Here, we would like to provide a brief basic overview, of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature, that can be used as a basis for revising clinical care, and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma than science.
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