Tolerance of fat emulsions in very-low-birth-weight neonates

Fluid and energy intakes and plasma concentrations of various lipid fractions were studied in 45 newborn infants, weighing between 820 and 1550 g, randomly assigned to one of three regimens for infusion of a fat emulsion: group 1, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 24 hours; group 2, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 16 hours, followed by a rest period of eight hours; and group 3, full dosage (4 g/kg) at a steady rate over 24 hours. At a given daily rate of infusion, mean plasma concentrations of the various lipid fractions tended to be higher in group 2 than in either group 1 or group 3. Plasma lipid concentrations correlated best with the hourly rate of lipid infusion, regardless of whether the infusion was continuous over 24 hours or intermittent.