Introduction of intravenous lipid administration on the first day of life in the very low birth weight neonate.
OBJECTIVE
To investigate lipid tolerance in sick, ventilator-dependent, very low birth weight infants from the first day of life and the effects of early introduction of intravenously administered lipid (IVL) on glucose homeostasis.


METHODS
Twenty-nine infants in the neonatal intensive care unit with birth weight less than 1500 gm received isocaloric, isonitrogenous parenteral feedings from day 1 with either IVL, 1 gm/kg from day 1 to 3 gm/kg from day 4 (group I; n = 16), or IVL added only from day 8 (group II; n = 13). Possible adverse clinical effects were monitored. Blood metabolites, nonesterified fatty acids, serum triglycerides, and insulin levels were determined daily. Arterial blood gases were measured and changes in partial pressures of oxygen and of carbon dioxide in arterial blood were compared between the two groups.


RESULTS
Early lipid infusion did not appear to have deleterious effects on blood gas tensions or to increase respiratory morbidity. The incidence of other adverse clinical effects that may be associated with IVL was not increased by earlier introduction of lipid. Serum lipid values were comparable to those of preterm infants receiving IVL at a later postnatal age. Blood glucose concentrations were higher in group II (mean, 7.50 (SEM 0.43) mmol/L) than in group I (mean, 6.01 (SEM 0.28) mmol/L; p less than 0.05). There was no evidence of increased gluconeogenesis in infants in group I and no correlation between blood glucose concentrations and serum nonesterified fatty acid concentrations.


CONCLUSIONS
When given infusion rates not exceeding 0.15 gm/kg/hr, sick, very low birth weight infants can tolerate IVL with stepwise dose increases from the first day of life without an increased incidence of possible adverse effects.
Department of Child Health, Charing Cross and Westminster Medical School, London, England.
N
N
Gilbertson
I Z
IZ
Kovar
D J
DJ
Cox
L
L
Crowe
N T
NT
Palmer
D001724:Birth Weight; D001786:Blood Glucose / Q000187:drug effects; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000494:pharmacology; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D007363:Intensive Care Units, Neonatal; D010288:Parenteral Nutrition; D011659:Pulmonary Gas Exchange / Q000187:drug effects
D001786:Blood Glucose; D005217:Fat Emulsions, Intravenous; D007328:Insulin