The Low Birth Weight Infant and Parenteral Nutrition

Morgan, Jane; Kovar, I Z

doi:10.1079/nrr19920010

Cited by 4 publications

(1 citation statement)

References 50 publications

(56 reference statements)

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“…Individuals were given up to 2 to 3 g/kg per day of Intralipid, conforming to Intralipid administration practice at that time. 9,17,18 Follow-up of the children had been performed at 18 months 19 and 7 years, 20 with a substudy at 15 years. 16 The initial preterm cohort consisted of 927 subjects ( Figure 1).…”

Section: Study Populationmentioning

confidence: 99%

Short-Term Exposure to Exogenous Lipids in Premature Infants and Long-Term Changes in Aortic and Cardiac Function

Lewandowski

Lazdam

Davis

et al. 2011

ATVB

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Objective-Intravenous lipid use is associated with an acute hyperlipidemia, but long-term consequences have not been studied. We investigated whether elevated lipids in humans during the critical period of preterm neonatal life have a long-term impact on aortic and myocardial function relevant to adult disease. Methods and Results-We followed up 102 subjects born prematurely and now aged 23 to 28 years. Eighteen received intravenous lipids as neonates and were matched to controls with equivalent perinatal characteristics. Global and regional aortic stiffness and left ventricular function were assessed by cardiovascular magnetic resonance. Those who received intravenous lipids had greater aortic stiffness in early adulthood (Pϭ0.0002), with greater stiffness in the abdominal aorta (Pϭ0.012). The relationship was graded according to the elevation in neonatal cholesterol induced by intravenous lipids (PϽ0.0001) but not other metabolic parameters altered by the infusion. Peak systolic circumferential strain was also reduced in the lipid group (Pϭ0.006), which, again, was proportional to neonatal cholesterol level (PϽ0.01). Key Words: aortic development Ⅲ cholesterol Ⅲ early development Ⅲ myocardial function Ⅲ young adults H yperlipidemia is a key biological driver for atherogenesis. 1-3 Lipid-rich fatty streaks first emerge in the aortic wall during fetal life and peak in prevalence during the first year following birth. 4,5 Newborn offspring of hypercholesterolemic mothers who have been exposed to abnormal lipid profiles have significantly more aortic fatty streaks which persist into adolescence. 6 Whether changes in the cardiovascular system are seen in those without a maternal history of hypercholesterolemia or those who are exposed to hyperlipidemia after birth is unknown but of potential importance because of its clinical relevance to a broader population and postnatal nutrition. Conclusion-Aortic See accompanying article on page 1939Therefore, we studied young adults whose mothers were normocholesterolemic but who were born prematurely and, as part of their routine clinical care, had received a brief, artificial, nutritional elevation in lipid levels postnatally in the form of an intravenous lipid infusion. Intralipid is widely used in parenteral nutrition as a source of energy and essential fatty acids. It consists of triglycerides in the form of soybean oil emulsified by egg phospholipid and glycerol. 7 Hypercholesterolemia secondary to Intralipid use is well described, likely driven by endogenous cholesterol synthesis as a result of delayed lipid clearance. [7][8][9] Because fatty streaks first appear in the aorta, 5 and in animal models arterial stiffness is the first pathophysiological change that occurs during this process, 10 we studied global aortic stiffness in early adulthood, measured as pulse wave velocity (PWV), a measure known to be relevant to later cardiovascular outcome in large-scale studies. 11 We used cardiovascular magnetic resonance imaging, 12 which, as it images the aorta directly, also...

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Section: Study Populationmentioning

confidence: 99%

Short-Term Exposure to Exogenous Lipids in Premature Infants and Long-Term Changes in Aortic and Cardiac Function

Lewandowski

Lazdam

Davis

et al. 2011

ATVB

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Metabolism of emulsions containing medium- and long-chain triglycerides or interesterified triglycerides

Hultin

Müllertz

Zundel

et al. 1994

Journal of Lipid Research

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Low birthweight infants and total parenteral nutrition immediately after birth. I. Energy expenditure and respiratory quotient of ventilated and non-ventilated infants.

Forsyth

Crighton

1995

Archives of Disease in Childhood - Fetal and Neonatal Edition

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The aim of this study was to determine the energy expenditure and respiratory quotient (RQ) of ventilated and nonventilated low birthweight infants during the first five days oflife, in order to determine optimal feeding regimens. Eighty six infants, of birthweight less than 1750 g, were grouped according to whether they were artificially ventilated or breathing air spontaneously, and whether they were parenteraily or enterally fed at the time of study. Energy expenditure and respiratory quotient were measured during days 1-5 and the relation of energy expenditure to several explanatory variables was investigated using multiple regression analysis. The energy expenditure of ventilated infants was less than that of spontaneously breathing infants; the differences were significant on days 1-3. The respiratory quotient (mean (SE)) was greater in intravenously fed infants compared with milk-fed -0-99 (0.03) v 0-92 (0.01) (P<0.05), with 42% of studies of infants receiving total parenteral nutrition (TPN) producing an RQ of >1O0 compared with 16.6% of milk-fed infants (P<0.01). There was a significant correlation between glucose intake and RQ (r=0*39, P<0.001). The activity scores were measured during 75 studies and scores were significantly higher in spontaneously breathing milk-fed infants compared with ventilated parenterally fed infants. Factors independently related to energy expenditure were: postnatal age (P<0.01); milk feeds (P<0.01); and physical activity (P<0.05).A mix of carbohydrate and fat from day 1 may not only meet energy needs but may also reduce respiratory quotient. (Arch Dis Child 1995; 73: F4-F7)

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The Low Birth Weight Infant and Parenteral Nutrition

Abstract: Energy (kcal/ kg) (kJ/kg) Protein (g/kg) Lipid (g / W Water (ml/kg) Zinc (pg/kg) Copper OLg/kg) Calcium (mg/kg) Phosphorus (mg/kg)

Cited by 4 publications

References 50 publications

Short-Term Exposure to Exogenous Lipids in Premature Infants and Long-Term Changes in Aortic and Cardiac Function

Short-Term Exposure to Exogenous Lipids in Premature Infants and Long-Term Changes in Aortic and Cardiac Function

Metabolism of emulsions containing medium- and long-chain triglycerides or interesterified triglycerides

Low birthweight infants and total parenteral nutrition immediately after birth. I. Energy expenditure and respiratory quotient of ventilated and non-ventilated infants.

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