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Impaired fat utilization in parenterally fed low-birth-weight infants suffering from sepsis
Insights
Lipid infusion in septic low-birth-weight infants is controversial. Septic infants showed impaired fat tolerance and reduced fat oxidation, necessitating lipid dosages not exceeding 2 g/kg/day.
Area of Science:
- Neonatalogy
- Pediatric critical care
- Nutritional science
Background:
- Lipid emulsion administration in low-birth-weight infants with sepsis remains a debated clinical practice.
- Assessing fat tolerance is crucial for optimizing parenteral nutrition in vulnerable infant populations.
Purpose of the Study:
- To investigate and compare fat tolerance in low-birth-weight infants with and without sepsis.
- To determine safe and effective lipid infusion rates for septic low-birth-weight infants.
Main Methods:
- Evaluated fat tolerance using serum triglyceride and free fatty acid concentrations.
- Assessed fatty acid oxidation via the [13C]triolein breath test.
- Compared lipid tolerance at 1, 2, and 3 g fat/kg body weight/day in septic and non-septic infants.
Main Results:
- Septic infants exhibited significantly higher triglyceride and free fatty acid levels at 3 g fat/kg/day compared to non-septic infants.
- Fatty acid oxidation was markedly reduced in septic infants (16.0%) versus non-septic infants (38.4%).
- Lipid dosages up to 2 g/kg/day were tolerated within normal ranges by both groups.
Conclusions:
- Low-birth-weight infants with sepsis demonstrate impaired lipid metabolism and reduced fat oxidation.
- Current lipid infusion guidelines should be adjusted for septic low-birth-weight infants.
- Recommended maximum lipid dosage for septic low-birth-weight infants is 2 g/kg/day to ensure safety and efficacy.
Abstract:
Lipid infusion in low-birth-weight infants suffering from sepsis is still controversial. Consequently, we investigated the fat tolerance in six low-birth-weight infants with sepsis and 15 low-birth-weight infants without sepsis. For measurement of fat clearance, we assayed the serum concentrations of triglycerides enzymatically, and of the free fatty acids by colorimetric micromethod. The fatty acid oxidation was analyzed with the [13C]triolein breath test by means of ratio-mass spectrometry. The infants were maintained on continuous parenteral nutrition with various amounts of soybean oil emulsion (1 g, 2 g, and 3 g fat/kg body weight per day). Comparing the lipid infusion of 1 and 2 g fat/kg body weight per day between the two groups, we found triglyceride and free fatty acid values in both groups to be in the normal range. At a dose of 3 g of fat/kg body weight per day, septic low-birth-weight infants showed a significantly higher concentration of triglycerides (2.02 +/- 0.46 mmol/liter) and of free fatty acids (2.06 +/- 0.45 mmol/liter) than the nonseptic low-birth-weight infants (triglycerides: 1.09 +/- 0.43 mmol/liter; free fatty acids: 1.05 +/- 0.41 mmol/liter). The low-birth-weight infants with sepsis showed a reduced fat oxidation rate of 16.0 +/- 1.5% in contrast to that of the low-birth-weight infants without sepsis, whose rate was 38.4 +/- 1.8%. Accordingly, we apply dosages not exceeding 2 g of fat/kg body weight per day to septic low-birth-weight infants.