Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study.

Giovanni Boscarino,Maria Di Chiara,Francesca De Luca,Giorgia Deli,Viviana Cardilli,Maria Giulia Conti,Giovanni Di Nardo,Pasquale Parisi,Marco Bianchi,Paola Favata,Gianluca Terrin

doi:10.3390/nu13041243

Abstract

(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case–control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4–10 days vs. 4 days, 95% CI 1–7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome.

Highlights

Our primary outcome was the rate of prolonged invasive mechanical ventilation while our secondary outcome was the rate of mortality during hospital stay
We demonstrated that HiTG in the first 7 days of life (DOL) is associated with a worse respiratory outcome in preterm newborns
We considered as the primary outcome the rate of prolonged invasive mechanical ventilation and not the occurrence of bronchopulmonary dysplasia (BPD)

Summary

Introduction

Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines recommend high energy intake in parenteral nutrition (PN) soon after birth [1]. This approach is referred to as “aggressive” nutrition. High serum levels of triglycerides (TG) are recognized as a metabolic complication of ILEs infusion, especially in very low birth weight infants (VLBW) [2]. In this population, the risk of hypertriglyceridemia (HiTG) is greater because of limited muscle and fat mass and reduced metabolic capacity due to a decreased hydrolytic capacity of the enzyme lipoprotein lipase [7].

Objectives

Methods

Conclusion