Parenteral lipid administration to very-low-birth-weight infants—early introduction of lipids and use of new lipid emulsions: a systematic review and meta-analysis123

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Background: The use of intravenous lipid emulsions in preterm infants has been limited by concerns regarding impaired lipid tolerance. As a result, the time of initiation of parenteral lipid infusion to very-low-birth-weight (VLBW) infants varies widely among different neonatal intensive care units. However, lipids provide energy for protein synthesis and supply essential fatty acids that are necessary for central nervous system development.

Objective: The objective was to summarize the effects of initiation of lipids within the first 2 d of life and the effects of different lipid compositions on growth and morbidities in VLBW infants.

Design: A systematic review and meta-analysis of publications identified in a search of PubMed, EMBASE, and Cochrane databases was undertaken. Randomized controlled studies were eligible if information on growth was available.

Results: The search yielded 14 studies. No differences were observed in growth or morbidity with early lipid initiation. We found a weak favorable association of non–purely soybean-based emulsions with the incidence of sepsis (RR: 0.75; 95% CI: 0.56, 1.00).

Conclusions: The initiation of lipids within the first 2 d of life in VLBW infants appears to be safe and well tolerated; however, beneficial effects on growth could not be shown for this treatment nor for the type of lipid emulsion. Emulsions that are not purely soybean oil–based might be associated with a lower incidence of sepsis. Large-scale randomized controlled trials in preterm infants are warranted to determine whether early initiation of lipids and lipid emulsions that are not purely soybean oil–based results in improved long-term outcomes.

Abbreviations:

BPD
bronchopulmonary dysplasia
CLD
chronic lung disease
EFA
essential fatty acid
IVH
intraventricular hemorrhage
MCT
medium-chain triacylglycerol
NEC
necrotizing enterocolitis
PNALD
parenteral nutrition–associated liver disease
PDA
patent ductus arteriosus
RCT
randomized controlled trial
ROP
retinopathy of prematurity
VLBW
very-low-birth-weight

Cited by (0)

1

From the Division of Neonatology, Department of Pediatrics, Erasmus MC–Sophia Children's Hospital, Rotterdam, Netherlands (HV, MABV, and CHPvdA); the Department of Pediatrics, Emma Children's Hospital–AMC, Amsterdam, Netherlands (MABV and JBvG); the Department of Epidemiology and Radiology, Erasmus MC, Rotterdam, Netherlands (SS); and the Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands (JBvG).

2

No funding was received for this project.

3

Address correspondence to JB van Goudoever, Emma Children's Hospital–AMC, c/o Room H7-282, PO Box 22660, 1100 DD Amsterdam, Netherlands. E-mail: [email protected].