IV fat emulsion (IVFE) is an integral part of the parenteral nutrition (PN) regimen in neonates. It provides a concentrated isotonic source of calories and prevents or reverses essential fatty acid deficiency. Continuous administration of IV fat with PN regimens prolongs the viability of peripheral IV lines in infants who might have limited venous access. IVFE must be administered separately from the PN solution in neonates. The acidic pH of a PN solution is necessary for maximum solubility of calcium and phosphorus. If fat emulsion is added to the PN solution, as is done in 3-in-1 (total nutrient admixture) solutions, the high amount of calcium and phosphorus needed by these infants may result in an unseen precipitate with serious consequences. Continuous fat infusion over 24 hours is the preferred method in neonates. The administration rate of 0.15 g/kg/hour for IVFE in the neonate should not be exceeded. Essential fatty acid deficiency can be prevented in neonates by providing IVFE in a dose of 0.5-1.0 g/kg/day. Carnitine is not routinely required to metabolize IVFE in the neonate. Infants should receive 20% lipid emulsion to improve clearance of triglycerides and cholesterol. Serum triglyceride levels should be maintained at <150-200 mg/dL in neonates. There are concerns about potential adverse effects of early administration of IV fat in very-low-birth-weight infants weighing <800 g. We hold the IV fat dose at 1.0-1.5 g/kg/day until the second week of life in infants <30 weeks gestation.
[Show abstract][Hide abstract] ABSTRACT: With increasing survival of extremely premature infants, emphasis is now focused on the quality of these survivors' lives. Possibly the most important factor in the premature's ability to survive in the NICU and thrive is the ability to replicate in utero growth through enteral and parenteral nutrition.
Current literature and review articles were retrieved from PubMed and personal files of the authors.
The use and complications of the various components of total parenteral nutrition (TPN) were reviewed. The composition of appropriate enteral feeds for the premature was reviewed as was the difficulties associated with the establishment of adequate enteral feeds in the premature infants.
Early initiation of amino acids in TPN and timely increases in the components of TPN can improve the caloric intake of prematures. Enteral feeds, particularly of breast milk, may be started within the first few days of life in all but hemodynamically unstable prematures. Newer lipid preparations show promise in reversing the hepatic damage of TPN associated cholestatic jaundice.
World Journal of Pediatrics 12/2008; 4(4):248-53. DOI:10.1007/s12519-008-0046-2 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The lipid intake at which a significant bilirubin-displacing effect occurs as a function of gestational age (GA) is unclear.
To determine the effect of gradual increase in IL intake from 1.5 to 3 g/kg per day on bilirubin-albumin binding variables as a function of GA in premature infants with indirect hyperbilirubinemia.
Infants of 24 to 33 weeks' gestation at birth who received IL (20% Intralipid [Fresenius Kabi, Uppsala, Sweden]) doses of 1.5, 2, 2.5, and 3 g/kg per day over 4 consecutive days were prospectively evaluated. The blood samples were drawn twice at least 8 hours apart on each IL intake to measure total serum bilirubin and free bilirubin by the peroxidase test. The highest free bilirubin on each IL intake, the corresponding total serum bilirubin, and serum albumin were used to calculate the bilirubin/albumin binding constant or binding affinity.
Sixty-two infants (median GA: 28 weeks) were studied during the first 10 days of life. None of the subjects had culture-proven sepsis, had triglyceride levels of >2.05 mmol/L, or were receiving steroids. Infants were grouped in 2-week GA intervals. The cumulative frequency of elevated free bilirubin concentration (>or=90th percentile or B(f) >or= 32 nmol/L) as a function of IL intake was inversely related to GA and was significantly different among 2-week GA groups. There was significant decrease in binding affinity and increase in free bilirubin concentration with higher IL intake for <or=28 week but not for >28 week GA groups.
The IL intake may be associated with a significant fall in the binding affinity of bilirubin for plasma protein and a concomitant increase in free bilirubin concentration in premature infants. The lipid intake at which this occurs depends on GA.
[Show abstract][Hide abstract] ABSTRACT: Parenteral nutrition can be a life-saving therapy, but its benefits need to be balanced with a unique set of risks and complications. Methods of practice vary because there is a dearth of research in the area of pediatric parenteral nutrition. This article reviews the available literature on parenteral nutrition in children and provides suggestions on prevention and management of parenteral nutrition-associated liver disease. Some of the issues discussed in this article include glucose infusion rates, cycling of parenteral nutrition, copper and manganese toxicity, and the provision of glutamine, selenium, and carnitine.
Nutrition in Clinical Practice 07/2009; 24(4):481-6. DOI:10.1177/0884533609339073 · 2.40 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.