Serum intralipid levels in neonates during parenteral nutrition: the relation to gestational age

To detect hyperlipidemia, serum Intralipid levels have been monitored by nephelometry (light scanning index) in children on total parenteral nutrition with glucose, amino acids, and Intralipid during the past 2 yr. Sufficient data were available in 93 neonates to analyze the effect of an Intralipid dose on serum levels in infants of different gestational ages. Guided by monitoring, Intralipid was given by constant infusion at a dose varying between 0.5 to 6.0 g/kg/day. Median post natal age at the start of therapy was 7 days. Gestational age varied from 27 to 32 wk in 36 infants (Group I), 33 to 36 wk in 18 (Group II), and was more than 37 wk in 39 (Group III). Of Group I infants, 28% developed hyperlipidemia (Intralipid level greater than 100 mg/100 ml) as compared to an incidence of 7% in Groups II and III. Peak Intralipid levels were highest in Group I and regression analysis also indicated that Intralipid was least well tolerated by this group. The dose response during the first 48 hr of Intralipid therapy was not significantly different from dose response later. Similarly, diagnosis did not seem to affect the dose-response. Dose recommendations were based on analysis of dose response lines. Even using these guidelines monitoring of serum Intralipid is advisable to avoid hyperlipidemia during Intralipid therapy. It is recommended that measurements of serum Intralipid be made several times per week in very low birth weight infants (Group I), and weekly in more mature neonates after a safe maximum Intralipid dose is established.