Hypertriglyceridemia and Intravenous Lipid Titration During Routine Parenteral Nutrition in Small Preterm Infants

Abstract

Objectives: In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity, and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR). Methods: We retrospectively reviewed data of preterm infants with a birth weight (BW) <1250 g consecutively admitted to our neonatal intensive care unit (2004–2016) who received routine PN. HiTG infants were defined by at least 1 triglyceride (TG) measurement >250 mg/dL during the first 10 days of life. Patients with and without HiTG were match-paired for BW and gestational age. Results: A total of 658 infants were analyzed and 196 (30%) had HiTG. One hundred thirty-six HiTG patients were matched with 136 CNTR. In the first 10 days of life, IV lipid, non-protein energy and total energy intakes, but not IV amino acids and carbohydrates, were significantly lower in HiTG infants. We found no differences between groups in diseases associated with prematurity. Anthropometry at 36 weeks (W), anthropometry at 2-year (Y) corrected age (CA), and neurodevelopment at 2Y CA were not different. Conclusions: Growth, diseases associated with prematurity, and neurodevelopment at 2Y CA in HiTG infants were similar to CNTR. This occurred despite a statistically significant albeit small reduction in IV lipid and non-protein energy intakes due to a strict TG monitoring and IV lipid titration at TG levels >250 mg/dL.

Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

“…More recently, in a retrospective study, Giretti et al [28] identified respiratory distress syndrome as a risk factor for HiTG in preterm newborns with BWs less than 1250 g. Despite the authors demonstrating an association between respiratory distress syndrome and lipid tolerance, the occurrence of respiratory distress syndrome preceded HiTG. In a similar population, the same research group, in a retrospective case-control study [29], did not find any relation between HiTG and BPD. Differently from our study, the authors did not correct the results for possible confounding variables.…”

Use of parenteral nutrition in term and late preterm infants: an Australian and New Zealand survey

“…They also recommend weekly monitoring of TG levels for infants on maintenance ILE. Whilst studies in very preterm infants found that growth, morbidities and neurodevelopment outcomes may not be affected by hypertriglyceridaemia (level > 2•8mmol/l) (37,38) , effects of TG levels or hypertriglyceridaemia on clinical outcomes in term and late preterm infants are unclear (3) .…”

Safety and Efficacy of Early High Parenteral Lipid Supplementation in Preterm Infants: A Systematic Review and Meta-Analysis

“…The current meta-analysis of the effects of early high IVLE administration on episodes of hypertriglyceridemia favored the control groups. Correani et al reported that, with close monitoring of hypertriglyceridemia and IVLE titration at TG levels > 250 mg/dL, infants whose TG level measured >250 mg/dL during early postnatal period did not have growth, disease, and neurodevelopmental disadvantages, unlike the control group [ 32 ]. Therefore, high IVLE administration appears to be safe for preterm infants with regular TG monitoring and IVLE titration.…”