Effects of Intralipid infusion on hemorheology and peripheral resistance in neonates and children

Abstract

Deleterious microcirculatory effects of Intralipid (IL) infusion may be caused by hemorheological or vascular effects. The aim of this investigation was to study vascular and hemorheological effects of IL in preterm and fullterm neonates and children. Ten preterm newborns, 10 fullterm neonates, and 10 children received an initial infusion of IL (0.6 g/kg) over 4 h. Calf blood flow (venous occlusion plethysmography), blood pressure (Dinamap), whole blood and plasma viscosity (capillary viscometer), red blood cell deformability (rheoscope), and erythrocyte aggregation (aggregometer) were measured before and after administration of IL. Plasma triglyceride levels showed the greatest increase in preterm infants. Whole blood viscosity decreased by about 10% in all three groups because of a similar reduction in hematocrit. Red blood cell aggregation decreased by about 20% after IL infusion. Blood pressure rose by 10%, and peripheral blood flow declined by about 10% in the three groups. Vascular hindrance, a calculation of blood pressure divided by blood flow and viscosity, was raised by about 20%, suggesting marked vasoconstriction of peripheral arteries. Vasoconstriction rather than hemorheological changes during infusion of IL may play a crucial role in the pathogenesis of circulatory alterations in parenterallyfed neonates.

Rapid Infusion of Fish Oil–Based Emulsion in Infants Does Not Appear to be Associated With Fat Overload Syndrome

“…Increased pulmonary vascular constriction can account for worsening of respiratory function, which has been associated with the use of these products. 9 Changes in the alveolararteriolar oxygen gradient can result in problems with gas exchange and may be due to diminished bioavailability of endothelial-derived vascular relaxant. 10,11 According to one report, infusions of IVFE can worsen bronchopulmonary dysplasia in premature infants.…”

“…Hypertriglyceridemia is the most common and can predispose patients to elevations in hepatic enzymes, hemolysis, and respiratory distress. Increased pulmonary vascular constriction can account for worsening of respiratory function, which has been associated with the use of these products 9 . Changes in the alveolar–arteriolar oxygen gradient can result in problems with gas exchange and may be due to diminished bioavailability of endothelial‐derived vascular relaxant.…”

A Summary of NICU Fat Emulsion Medication Errors and Nursing Services

“…Deterioration of pulmonary function may be partially due to an increased pulmonary vascular constriction and, therefore, resistance. 26 Complications of intralipid infusion include vasoconstriction, leading to hypertension, 27,28 and gas exchange problems with changes in the alveolar-arteriolar oxygen gradient. 29 The underlying mechanisms may relate to diminished bioavailability of endothelial-derived vascular relaxant.…”

Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

“…Other potential consequences of prolonged administration of IVFEs include hematologic abnormalities with recurrent thrombocytopenia and hyperactivation of the monocyte‐macrophage system 94 . Worsening of respiratory function may be due to increased pulmonary vascular constriction 95 . Changes in the alveolar‐arteriolar oxygen gradient can lead to decreased gas exchange and may be due to diminished bioavailability of endothelial‐derived vascular relaxants 96 .…”