Parenteral lipid administration to very-low-birth-weight infants—early introduction of lipids and use of new lipid emulsions: a systematic review and meta-analysis

Vlaardingerbroek, Hester; Veldhorst, Margriet A. B.; Spronk, Sandra; Akker, Chris H.P. van den; Goudoever, Johannes B. van

doi:10.3945/ajcn.112.040717

Cited by 109 publications

(88 citation statements)

References 47 publications

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“…1,5,[13][14][15][16] Lipids emulsions help to reach the high caloric requirements of preterm and are the unique source of essential fatty acids. Lipids should account for 25-40% of non-protein calories.…”

Section: Lipidsmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative. IntroductionThe improvement of neonatal care has led to an increase in the survival rate of very low birth weight infants (VLBW) infants (<1500 g). Nonetheless, growth failure is still a very frequent issue with incidence that ranges from 43 to 97% among various neonatal units. Thus, more aggressive nutritional strategies have been developed: first the parenteral nutrition then the enteral nutrition. Parenteral nutrition is often the only source of nutrients that can be used during the period of clinical instability. 1 Enteral nutrition must be gradually introduced as soon as possible; in presence of a good enteral tolerance, the parenteral nutrition should be rapidly discontinued, thus reducing its related side effects. 2 Parenteral nutritionAssuring an adequate nutrition to preterm infants is a real challenge, especially during the first hours after birth, when a total parenteral nutrition (TPN) is needed to meet the high nutritional requirements but it is often complicated by glucose and lipids intolerance. 3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life. It can be prescribed in individualized or standardized administration; PN is provided through a central catheter (umbilical vein catheter or percutaneous central catheter) or, temporarily, via a peripheral route in the case of partial parenteral solutions and low osmolar load (<600 mOsm/L). Fluids and electrolytesIn the first week of life changes occur in the extracellular and intracellular compartments, resulting in a redistribution of fluids. This is one of the reason that explains the weight loss (5-10% of birth weight) that usually takes place during the first days of life. The fluid intake in the newborn (VLBW) and very low birth weight (ELBW) starts with 80-90 mL/kg/day and then is gradually increased by 10-20 mL/kg/day up to 160-180 and 150-160 mL/kg/day, respectively. 2,5-8 Electrolytic supplementation usually begins on the third-fourth day of...

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Section: Lipidsmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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“…35 A systematic review of the early introduction of lipids (defined as introduction within the first 2 days after birth) and the use of new lipid emulsions included 14 RCTs. 36 Early initiation of lipids had no impact on any of the outcome measures, including death, bronchopulmonary dysplasia, necrotising enterocolitis, patent ductus arteriosus, sepsis, intraventricular haemorrhage, significant jaundice and hypertriglyceridaemia. The meta-analysis of the effects of lipid emulsions that are not purely soya bean based showed no difference in outcomes of death, duration of respiratory support or rate of weight gain.…”

Section: Previous Studies Of Parenteral Nutritionmentioning

confidence: 99%

“…However, the authors concluded that large-scale RCTs are needed to determine the efficacy of newer lipids. 36 We recently published a systematic review of preterm PN summarising the evidence to date. 37 The review concludes that the evidence base for current recommendations is based on historical evidence and there are no long-term studies of the impact of PN on health and neurodevelopment.…”

Section: Previous Studies Of Parenteral Nutritionmentioning

confidence: 99%

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

et al. 2016

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Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners.Whilst further distribution of specific materials from within this archive is forbidden, you may freely distribute the URL of WestminsterResearch: ((http://westminsterresearch.wmin.ac.uk/).In case of abuse or copyright appearing without permission e-mail repository@westminster.ac.uk This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). EFFICACY AND MECHANISM EVALUATION Efficacy and Mechanism EvaluationEditorial contact: nihredit@southampton.ac.ukThe full EME archive is freely available to view online at www.journalslibrary.nihr.ac.uk/eme. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Efficacy and Mechanism Evaluation journalReports are published in Efficacy and Mechanism Evaluation (EME) if (1) they have resulted from work for the EME programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. EME programmeThe Efficacy and Mechanism Evaluation (EME) programme was set up in 2008 as part of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC) coordinated strategy for clinical trials. The EME programme is broadly aimed at supporting 'science driven' studies with an expectation of substantial health gain and aims to support excellent clinical science with an ultimate view to improving health or patient care.Its remit includes evaluations of new treatments, including therapeutics (small molecule and biologic), psychological interventions, public health, diagnostics and medical devices. Treatments or interventions intended to prevent disease are also included.The EME programme supports laboratory based or similar studies that are embedded within the main study if relevant to the remit of the EME programme. Studies that use validated surrogate markers as indicators of health outcome are also considered.For more information about the EME programme please visit the website: http://www.nets.nihr.ac.uk/programmes/eme This reportThe research reported in this issue of the journal was funded by the EME programme as project number 08/99/04. The contractual start date was in February 2010. The final report began editorial review in January 2015 and was accepted for publication in October 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The EME edit...

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“…La introducción precoz de soluciones lipídicas (entre 12 horas y 2 días tras el nacimiento) ha mostrado ser segura comparada con la introducción tardía (16,17), mejorar el balance nitrogenado y revelar una tendencia a menor tasa de hiperglucemia (16).…”

Section: Requerimientos De Lípidosunclassified

“…Respecto a la composición de la emulsión lipídica en RN, la comparación de aquellas basadas en aceite de oliva, aceite de pescado y las mezclas de aceite de soja con triglicéridos de cadena media (MCT) (16), han mostrado ser seguras frente a las procedentes de soja, con una incidencia similar de efectos adversos. Estas mezclas alternativas presentan beneficios desde un punto de vista fisiopatológico, como disminución del estrés oxidativo, reducción del contenido en fitoesteroles, activación del sistema retículo-endotelial (18) o vasodilatación pulmonar, que han sido demostrados en ensayos clínicos en modelos animales (19) y/o RN prematuros (20).…”

Section: Requerimientos De Lípidosunclassified

Nutrición parenteral en situaciones clínicas especiales

Martínez¹,

Giner

2017

Nutr Hosp

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RECIÉN NACIDO PREMATUROLa nutrición parenteral (NP) constituye un pilar fundamental en la nutrición del recién nacido (RN) prematuro, especialmente en el RN muy prematuro (< 32 semanas de gestación) y RN prematuro extremo (< 28 semanas de gestación) (1). En estos pacientes, la administración de una NP balanceada y precoz se considera de elección (2). Dos metaanálisis han demostrado que la NP precoz en el RN prematuro < 1.500 g es segura, sin aumentar el riesgo de efectos adversos (3,4), y ha mostrado beneficios en relación con un balance nitrogenado positivo (ver aporte proteico) y mayor ganancia ponderal respecto a controles, aunque no se ha observado mayor longitud o perímetro craneal al alta en el grupo de intervención (3). Cabe destacar que los ensayos clínicos analizados cuentan con pequeño tamaño muestral y son heterogéneos (3,4). NECESIDADES ENERGÉTICASLa evidencia sobre las necesidades energéticas del RN prematuro es muy escasa, pues desde una aproximación empírica es muy difícil desligar el efecto de la energía administrada del obtenido por el aporte proteico y resto de nutrientes. Por tanto, las recomendaciones energéticas del RN prematuro se basan en el método factorial, asumiendo que su composición corporal es similar a la del feto y que el crecimiento debería ser similar al que ocurre intraútero (5). Actualmente, se recomienda un aporte inicial de 60 kcal/kg/día, con aumento rápido y progresivo hasta las 90-100 kcal/kg/día en la primera semana (1). Posteriormente se irá incrementado en función del peso de RN (2,6), con el objetivo de conseguir un crecimiento lo más próximo al crecimiento fetal (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" en las tablas II y III). MODIFICACIONES EN EL DISEÑO DEL PREPARADO DE NP Requerimientos proteicosEl aporte proteico mínimo para conseguir un balance nitrogenado positivo en el RN prematuro es 1,5 g/kg/día (6). No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas. Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).La fórmula de AA a administrar debe contener cisteína, tiro...

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Parenteral lipid administration to very-low-birth-weight infants—early introduction of lipids and use of new lipid emulsions: a systematic review and meta-analysis

Cited by 109 publications

References 47 publications

Feeding of preterm infants and fortification of breast milk

Feeding of preterm infants and fortification of breast milk

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

Nutrición parenteral en situaciones clínicas especiales

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