Successful exchange transfusion in extremely preterm infant after symptomatic lipid overdose

Area of Science:

• Neonatalogy
• Pediatric Critical Care
• Clinical Pharmacy

Background:

• Intravenous lipid administration, while generally safe, carries risks, particularly with rapid infusion of intravenous fat emulsion (IVFE).
• Accidental overdose of IVFE can occur due to equipment malfunction or administration errors.

Observation:

• An extremely preterm infant received a massive overdose of IVFE due to device failure.
• The infant presented with lethargy, apnea, metabolic acidosis, and hemodynamic instability, necessitating mechanical ventilation and inotropic support.

Findings:

• Despite IVFE discontinuation and supportive care, the infant's condition and metabolic acidosis worsened.
• A double-volume exchange transfusion was performed, leading to immediate normalization of serum triglyceride levels and laboratory data.
• The infant was successfully extubated, weaned from inotropic support, and discharged at 40 weeks corrected age with normal neurological outcomes.

Implications:

• Double-volume exchange transfusion is a viable and effective treatment for symptomatic hypertriglyceridemia caused by IVFE overdose in neonates.
• This intervention should be considered even in extremely preterm infants with severe complications.
• Highlights the importance of vigilant monitoring and prompt management of IVFE administration errors in neonatal intensive care units.