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Randomised trial of effect of delayed intravenous lipid administration on chronic lung disease in preterm neonates
M H Alwaidh1, L Bowden, B Shaw
1Neonatal Unit, Liverpool Maternity Hospital, England.
Insights
Delaying intravenous lipid (IVL) administration in preterm neonates did not significantly reduce the incidence of chronic neonatal lung disease (CNLD). Further research with a larger sample size is needed to confirm these findings for neonatal intensive care.
Area of Science:
- Neonatology
- Pediatric critical care
- Neonatal nutrition
Background:
- Chronic neonatal lung disease (CNLD) incidence increased significantly in preterm neonates.
- Early administration of intravenous lipids (IVL) was linked to a higher risk of CNLD.
- Logistic regression identified early IVL as an independent risk factor for CNLD.
Purpose of the Study:
- To investigate if delaying IVL administration from day 5 to day 14 reduces CNLD incidence in preterm neonates.
- To determine if a delayed IVL strategy can halve the occurrence of CNLD.
- To assess the impact of IVL timing on neonatal respiratory outcomes.
Main Methods:
- Prospective randomized study involving 64 preterm neonates (<1,500 g birth weight).
- Infants were randomized to receive IVL on day 5 or day 14 of postnatal life.
- Intention-to-treat analysis was employed due to variations in parenteral nutrition needs.
Main Results:
- The relative risk of CNLD at 28 postnatal days was 1.15 (95% CI: 0.81-1.62).
- The relative risk of CNLD at 36 weeks postconception was 1.08 (95% CI: 0.59-1.99).
- These relative risks were not statistically significant compared to a risk of 1.
Conclusions:
- Delaying IVL administration to day 14 did not significantly decrease the incidence of CNLD in preterm neonates.
- A much larger study population, exceeding 2,000 infants, is required to definitively assess the impact of delayed IVL on CNLD rates.
- Current findings suggest that the timing of IVL initiation may not be a primary modifiable factor for preventing CNLD in this population.
Abstract:
A recent sevenfold increase in the annual incidence of chronic neonatal lung disease (CNLD) on an intensive care unit was attributed to the early administration of intravenous lipid (IVL) in ventilated preterm neonates. When logistic regression was used to eliminate other confounding variables, early delivery of IVL was independently associated with an eight-fold increase in the likelihood of CNLD. Consequently, we designed a prospective study to detect a halving of the incidence of CNLD by delaying IVL administration from 5 days (as is routine practice) to 14 days. Sixty-four parenterally fed preterm neonates weighing < 1,500 g at birth were randomised to receive IVL either on day 5 or day 14. Analysis was by intention to treat, since several infants in the latter group required no parenteral nutrition by day 14. Our results showed that the relative risk (95% confidence interval) of CNLD at 28 postnatal days was 1.15 (0.81-1.62); at 36 weeks postconception, it was 1.08 (0.59-1.99). A study population of > 2,000 would be required to determine whether these relative risks were significantly different from 1.