Intravascular fat accumulation after Intralipid infusion in the very low-birth-weight infant

Abstract

RECENTLY THREE GROUPS of investigators ~3 have warned against the use of intravenous infusion of Intralipid (Vitrum, Stockholm) to sick low-birth-weight infants with pulmonary disease after they had demonstrated accumulation of lipid material in the lung capillaries in some of these infants. Since no controls were included in these studies, we have investigated the lungs and brains of 24 low-birth-weight infants who had died in Our department within the last 30 months. SUBJECTS AND METHODS Among the 24 infants autopsy was not allowed by the parents in one case, and in two cases lung material was not suitable for histologic investigation. Mean birth weight of the remaining 21 infants was 1,050 gm (range 540 to 1,440). Mean gestationaI age was 29 weeks (range 28 to 34). There were 10 boys and 11 girls. Thirteen had one-minute Apgar scores below 7. Seventeen were treated with assisted ventilation for one to 19 days. Thirteen developed intracranial hemorrhage, six developed septicemia, and two had neCrotizing enterocolitis. Nine of the 21 infants had been treated with 20% Intralipid (+IL) for an average of eight days (range 1 to 27) and had received 2.0 _+ 0.5 gm/kg/day (mean _+ 1 SD) of fat infused continuously over 24 hours. The maximum amount of fat given was 3.4 _+ 1.2 gm/kg/day. The clearance of IL was evaluated by daily visual inspection of the plasma sampled during infusion. Twelve of the 21 infants had been fed human milk (mean 46 ml/kg/day, range 0 to 231 ml/kg/day) and given carbohydrate solutions intravenously, but no IL (-IL). There were no differences between the two groups with respect to gestational age, birth weight, and Apgar scores. The survival time, however, was lower in -IL compared with +IL infants (P < 0.01). The lungs and the brains were fixed in 10% formolsaline. Two tissue blocks were taken from each lung and