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Variations in intralipid tolerance in newborn infants
Intravenous Intralipid tolerance tests (IVLTT) were done in 26 newborn infants of 26-40 wk gestational ages. The clearance constants (k2) ranged from 1.2-12.7 (%/min) after bolus injections given within 4.5 h (n = 12) or daily (n = 13). Significant variation (17-31%) occurred, similar to adults, and was unrelated to the time or dose given. Eleven infants received continuous Intralipid infusions for 10-24 h at a rate calculated to maintain a plasma Intralipid plateau concentration of 100 mg/dl. Nine infants did not exceed this optimal plasma level, although four could have tolerated more Intralipid. Two infants exceeded the ideal plasma concentration (greater than 100 mg/dl). All infants achieved and maintained plateaus within 5 h. Neither day-to-day variations nor the bolus dose used to establish clearance characteristics, accounted for the discrepancies in plateaus achieved. These studies identify some limitations of the IVLTT as a predictor of Intralipid utilization during continuous infusion, and the need for early monitoring of plasma Intralipid concentrations to optimize the therapeutic dose given to newborn infants.
Intravenous Intralipid tolerance tests (IVLTT) were done in 26 newborn infants of 26-40 wk gestational ages. The clearance constants (k2) ranged from 1.2-12.7 (%/min) after bolus injections given within 4.5 h (n = 12) or daily (n = 13). Significant variation (17-31%) occurred, similar to adults, and was unrelated to the time or dose given. Eleven infants received continuous Intralipid infusions for 10-24 h at a rate calculated to maintain a plasma Intralipid plateau concentration of 100 mg/dl. Nine infants did not exceed this optimal plasma level, although four could have tolerated more Intralipid. Two infants exceeded the ideal plasma concentration (greater than 100 mg/dl). All infants achieved and maintained plateaus within 5 h. Neither day-to-day variations nor the bolus dose used to establish clearance characteristics, accounted for the discrepancies in plateaus achieved. These studies identify some limitations of the IVLTT as a predictor of Intralipid utilization during continuous infusion, and the need for early monitoring of plasma Intralipid concentrations to optimize the therapeutic dose given to newborn infants.