Abstract
The objective of this systematic review and meta-analysis was to summarize the effects of early initiation and achievement of a high dose of parenteral lipids (≥1.5 g/kg/day reached within the first 24 h of birth) on growth and adverse outcomes in preterm infants. PubMed, EMBASE, and Cochrane databases were utilized to search for publications for this meta-analysis. Randomized controlled trials were eligible if data on growth or clinical outcome was available. The search returned nine studies. The mean proportion of postnatal weight loss (%) was lower (mean difference [MD]: −2.73; 95% confidence interval [CI]: −3.69, −1.78), and the mean head circumference near the term equivalent age (cm) was higher in the early high lipid treatment group (MD: 0.67; 95% CI: 0.25, 1.09). There was a favorable association of early high lipid administration with the incidence of extrauterine growth restriction (relative risk [RR]: 0.27; 95% CI: 0.15, 0.48). Generally, there were no differences in morbidities or adverse outcomes with early high lipid administration. Early initiation of parenteral lipids and high dose achieved within the first 24 h of life appear to be safe and endurable and offer benefits in terms of growth.
Highlights
The goal of nutrition for preterm infants is to mimic the intrauterine growth rate and to achieve favorable long-term developmental outcomes
A study in France reported that early introduction of parenteral lipids improved neonatal growth and that the lipid dose was positively associated with weight gain in very preterm infants [6] and possible later neurodevelopmental outcomes [7]
The main strength of the current study was that we considered the importance of achieving a high administration dose early as well as early initiation of intravenous lipid emulsion (IVLE), which was distinctly different from previous meta-analyses
Summary
The goal of nutrition for preterm infants is to mimic the intrauterine growth rate and to achieve favorable long-term developmental outcomes. Despite recent enhanced nutritional support in neonatal medicine [1,2], achieving this weight gain goal is still very difficult, especially during the first week of life when preterm infants are exposed to highest risk of undernutrition. Insufficient nutrition during this critical period results in cumulative energy and protein deficits that aggravate the postnatal weight loss [3]. “early” is not defined as an immediate time, but in a recently published randomized controlled study on the administration of IVLE in very preterm infants, researchers compared more immediate timing, within 6 h after birth versus between 12 and 24 h after birth, showing that the provision of a high amount of lipids early results in less weight loss and better head growth, in terms of the z-score [9]
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