Randomized Trial of Very Low Birth Weight Infants Receiving Higher Rates of Infusion of Intravenous Fat Emulsions During the First Week of Life

Drenckpohl, Douglas; McConnell, Connie; Gaffney, Shirley; Niehaus, Matt; Macwan, Kamlesh S.

doi:10.1542/peds.2007-2282

Cited by 92 publications

(78 citation statements)

References 37 publications

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“…Greater protein intake is associated with greater weight gain and linear growth in preterm babies fed fortified breast milk, independent of the calorie intake [19]. Greater protein and lipid intakes are also associated with reduced morbidity in preterm babies [20,21], suggesting that the reduced protein and lipid intake in the HYPER and INS groups may have contributed to greater morbidity, which may then also have affected growth.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Hyperglycaemia Increases Mortality and Morbidity in Preterm Lambs

Alsweiler¹,

Harding²,

Bloomfield³

2012

Neonatology

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Background: Hyperglycaemic preterm babies suffer increased mortality and morbidity, but it is not known if these associations are causal or if treatment with insulin improves outcome. Objectives: We aimed to investigate the effect of neonatal hyperglycaemia, and its treatment with insulin, on mortality and morbidity in preterm lambs. Methods: Preterm lambs (137 days’ gestation; term = 148 days) were randomised to a 12-day intravenous infusion of saline (PremC; n = 39), 50% dextrose (HYPER; n = 47), or 50% dextrose + insulin (INS; n = 21). Term controls (TermC; n = 19) received saline. Dextrose and insulin infusions were titrated to maintain blood glucose concentrations (BGC) at 10–12 mmol·l^–1 (HYPER) or 4–6 mmol·l^–1 (INS). Results: HYPER lambs had higher BGC (mean (SEM); TermC: 5.6 (0.1), PremC: 5.5 (0.1), HYPER: 10.8 (0.6), INS: 6.2 (0.3) mmol·l^–1; p < 0.0001), higher mortality (n (%); TermC: 0, PremC: 2 (5), HYPER: 11 (23), INS: 0; p < 0.001), higher incidence of fever (n (%); TermC: 3 (16), PremC: 13 (33), HYPER: 26 (55), INS: 6 (29); p = 0.01) and lower weight gain (mean (SEM); TermC: 45.9 (2.9), PremC: 44.2 (2.1), HYPER: 28.4 (1.9), INS: 28.7 (2.8) g·kg^–1·day^–1; p < 0.0001). Conclusions: Neonatal hyperglycaemia in preterm lambs causes increased mortality and morbidity, and decreases growth. Insulin treatment to restore euglycaemia attenuated the increased mortality and morbidity, but not the decreased growth.

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Section: Discussionmentioning

confidence: 99%

Neonatal Hyperglycaemia Increases Mortality and Morbidity in Preterm Lambs

Alsweiler¹,

Harding²,

Bloomfield³

2012

Neonatology

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“…Currently there is no clear consensus for initial lipid dose and increments in the first week of life. A randomized controlled trial (RCT) by Drenckpohl et al [8] compared high-dose versus lowdose i.v. lipids in 110 preterm neonates (birth weight 750-1500 g).…”

Section: Discussionmentioning

confidence: 99%

Lipids for parenteral nutrition in neonates

Deshpande

Simmer

2011

Current Opinion in Clinical Nutrition and Metabolic Care

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Since the first soybean oil-based lipid emulsions were introduced 50 years ago, progress has been made in understanding the composition, dose and clinical effects of parenteral lipids in neonatal patients. However there is a paucity of data in terms of definitive head-to-head trials of different novel lipid emulsions evaluating short-term as well as long-term clinically important outcomes including neurodevelopment. Future research is required to determine long-term benefits of novel lipid emulsions for neurological outcome and effects on the immune system.

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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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Randomized Trial of Very Low Birth Weight Infants Receiving Higher Rates of Infusion of Intravenous Fat Emulsions During the First Week of Life

Abstract: Very low birth weight infants can tolerate higher rates of infusion of intravenous fat emulsion solutions during the first week of life without significant adverse events.

Cited by 92 publications

References 37 publications

Neonatal Hyperglycaemia Increases Mortality and Morbidity in Preterm Lambs

Neonatal Hyperglycaemia Increases Mortality and Morbidity in Preterm Lambs

Lipids for parenteral nutrition in neonates

Feeding of preterm infants and fortification of breast milk

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