Lipids in total parenteral nutrition for premature infants.

Abstract

Background Lipids of TPN can cause liver toxicity in premature infants, so it is important to evaluate the introduction of new emulsions Purpose To describe the safety of two lipid emulsions used in the compounding of total parenteral nutrition (TPN) for premature infants. Materials and methods A retrospective study of two time periods, 2009 and 2010, of preterm infants population whit TPN. The analysis excluded those cases of death, sepsis and those who had a liver disease. 20 children received parenteral nutrition with lipid emulsion derived from soybean oil (Intralipid ®), from August to December 2009. In the second group were evaluated 19 children, whose lipid emulsion was derived from olive oil (ClinOleic ®) in the period from August to December 2010. The authors evaluated the following criteria: levels of bilirubin and liver enzymes (ALT/AST) and maximum insulin requirements (IU/kg/h). Results 39 infants within 72 h of life completed the study. The group that received parenteral nutrition with soybean oil derived (n=20) showed a mean gestational age of 31.4 weeks (27-34) and an average weight of 1.64 kg (0.76-2.8), the second group with lipids olive oil derived (n=19) 30.4 weeks (28-32) of age and weighing 1.82 kg (0.6-.2.28). Bilirubin levels were similar in both groups: soybean 8.4 mg / dl (2.4-20.02) and olive 9.1 mg / dl (2,52-16.9). There were no significant differences in levels of liver enzymes AST of 43.6 U/L (17-235.3) and ALT of 5.21 U/L (4.1-9.2) and oil olive group AST 43.1 U/L (19.2-170.3) and 13.7 U/L (5.2-37.3) ALT. In the study population also did not show higher insulin requirements in any of the two groups referred to maximum needs, 0.034 UI/kg/h (0.02-0.03) versus 0.036 IU/kg/day (0.02-0.035). Conclusions Both lipid emulsions were well tolerated, showing no difference in hepatic damage. The results suggest that both lipid preparations have similar safety profile in preterm parenteral nutrition.

ESPEN guidelines on chronic intestinal failure in adults

“…Protein and/or EFA deficiency is associated with steatosis in animal studies [564]. Deficiencies in methionine metabolites (choline, carnitine, and taurine) can result in hepatic steatosis and chronic cholestasis in premature infants [565]. Taurine supplementation has been shown to be effective in decreasing cholestasis in neonates and infants [566], but there are no comparable studies in adults.…”