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Gabriel K, Hovater K, Gao H, de la Cruz D, Calkins KL, Neu J. Monitoring and management of hypertriglyceridemia in extremely low birth weight neonates receiving intravenous lipid emulsions: A national survey. Early Hum Dev 2023; 186:105872. [PMID: 37862901 DOI: 10.1016/j.earlhumdev.2023.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
AIM To assess the practice variation of defining, monitoring and managing hypertriglyceridemia (HTG) in extremely low birth weight neonates receiving intravenous lipid emulsions (IVLE). METHODS An 8-question survey created via the web survey site Qualtrics was distributed to neonatologists, neonatal nurse practitioners and fellows within the Section of Neonatal-Perinatal Medicine email directory list in the United States and Canada. Survey results were obtained between August and September 2022. RESULTS There were 249 respondents from approximately 4000 members within the Section of Neonatal-Perinatal Medicine. Responses were documented as a frequency (percentage) with a margin of error of plus or minus 6.2 %. Most respondents were neonatologists, individuals practicing for >10 years and reported a unit-based policy for IVLE initiation and advancement. The definitions of HTG varied among respondents, with the majority (42.7 %) reporting a defining threshold of >200 mg/dL. Nineteen percent of respondents reported not routinely monitoring serum triglyceride concentrations with variable triglyceride monitoring intervals reported by other survey respondents. Regarding elevated triglyceride concentrations, 19.0 % reported decreasing the IVLE rate and checking triglyceride concentrations until normalization; 14.6 % reported IVLE discontinuation and monitoring triglyceride concentrations until normalization; 61.9 % reported using a combination of the above practices; and 4.4 % reported individualized practices for IVLE management with elevated triglyceride concentrations. CONCLUSION This survey demonstrates a high variation in defining, monitoring and managing HTG in extremely low birth weight neonates and emphasizes the need for studies to better guide this practice.
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Affiliation(s)
- Krystina Gabriel
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States.
| | - Kylie Hovater
- Bachelor of Science Student, College of Liberal Arts and Sciences, University of Florida, 102 Griffin-Floyd Hall, Gainesville, FL 32611, United States
| | - Hanzhi Gao
- Research Design and Data Coordinating Center, Clinical and Translational Science Institute, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, United States
| | - Diomel de la Cruz
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, United States
| | - Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32608, United States
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2
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Sasenick J, Kleinfeld A, Huber A, Oh W, Hegyi T, Weinberger B. Effects of lipid emulsions on unbound bilirubin and response to phototherapy in preterm infants. J Matern Fetal Neonatal Med 2022; 35:10395-10400. [PMID: 36176060 PMCID: PMC9852034 DOI: 10.1080/14767058.2022.2128656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Bilirubin-induced neurotoxicity is mediated by the fraction of total serum bilirubin (TSB) not bound to albumin (Bf). Unbound free fatty acids (FFAu) generated from lipid emulsions compete with bilirubin for albumin binding, increasing Bf. Soy-based (IL) and soy-MCT-olive-fish oil-based (SMOF) lipid emulsions contain different fatty acids with distinct albumin binding affinities. IL increases Bf in preterm infants, but the effects of SMOF on Bf are not known. Our objective was to compare changes in TSB, Bf, FFAu, and response to phototherapy in preterm infants receiving SMOF and IL. We hypothesized that SMOF would be associated with lower Bf and better response to phototherapy than IL. METHODS Very preterm and low birth weight infants (<1500 g, <32 weeks) were infused with IL (n = 20) or SMOF (n = 20) as prescribed by providers. Phototherapy was prescribed using the standard care practice. FFAu profiles and levels, TSB, and Bf were measured on 0, 1, 2, and 3 g/kg/day of lipid infusion and at the initiation and termination of phototherapy. TSB was analyzed in the clinical laboratory using the diazo technique. FFAu and Bf were measured using fluorescent probes. RESULTS Escalating doses of IL and SMOF increased FFAu levels and Bf, but not TSB. Phototherapy did not significantly decrease Bf for infants receiving either lipid. IL-treated infants had higher levels of unbound linoleic acid, and SMOF-treated infants had higher unbound arachidonic, oleic, and docosahexaenoic acids. CONCLUSIONS IL and SMOF both increase Bf similarly, and phototherapy does not significantly affect Bf for infants receiving them.
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Affiliation(s)
- Jonathan Sasenick
- Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
| | | | - Andrew Huber
- Fluoresprobe Sciences, San Diego, CA, United States
| | - William Oh
- Women and Infants Hospital and AdventHealth for Children, Providence, RI, United States
| | - Thomas Hegyi
- Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Barry Weinberger
- Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
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3
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Burdine J, Franco-Fuenmayor ME, Huff ML, Shattuck KE. Rapid infusion of fish oil-based lipid emulsions: Is there a risk of fat overload syndrome? A case report of rapid administration. J Clin Pharm Ther 2022; 47:1088-1090. [PMID: 35304749 DOI: 10.1111/jcpt.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Errors involving the delivery of IVFE containing soybean oil have known significant complications, including fat overload syndrome. However, little is known regarding the risks of fat overload syndrome with other types of lipid emulsions. CASE SUMMARY We describe a medication administration error that resulted in rapid fish oil-base lipid emulsion (Omegaven) infusion in a five-month-old infant with parenteral nutrition associated liver disease (PNALD). The medication administration error resulted in bolus infusion of Omegaven over 12 min (5 g/kg/h) instead of 12 h (0.083 g/kg/h). WHAT IS NEW AND CONCLUSION No adverse reactions were notes because of the rapid infusion, supporting conclusion that rapid infusion of fish oil will not result in fat overload syndrome.
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Affiliation(s)
- Jordan Burdine
- Department of Pharmacy, UTMB Health, Galveston, Texas, USA
| | | | - Monica L Huff
- Department of Pediatrics, UTMB Health, Galveston, Texas, USA
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4
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Cober MP, Gura KM, Mirtallo JM, Ayers P, Boullata J, Anderson CR, Plogsted S. ASPEN lipid injectable emulsion safety recommendations part 2: Neonate and pediatric considerations. Nutr Clin Pract 2021; 36:1106-1125. [PMID: 34705289 DOI: 10.1002/ncp.10778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Lipid injectable emulsions (ILEs) are complex pharmaceutical formulations intended as a source of energy and fatty acids for parenteral nutrition (PN) therapy. Part 1 of this series addressed issues associated with and safety recommendations pertaining to adult ILE use. Part 2 addresses ILE safety in neonatal and pediatric patients. Considerations for ILE use in the neonatal and pediatric populations differ from those of adults. For example, these patients often require higher doses compared with adult counterparts to support growth, development, and daily metabolic needs. ILE is also frequently administered as a separate infusion as opposed to in a total nutrient admixture owing to compatibility and stability issues and limitations to intravenous access in the neonatal and pediatric populations. ILE is the most frequent PN ingredient associated with PN errors occurring in the administration, prescribing, and transcribing processes. Concerns exist with use of in-line filters and repackaging of commercial products for infusion. ILE use in neonatal and pediatric patients has been associated with both minor and major adverse effects, which most often occur with doses exceeding manufacturer recommendations. Gaps in ILE best practices for neonatal and pediatric patients predispose to errors in the PN use system. This paper describes safe-use considerations for ILE products available in the United States in neonatal and pediatric patients, including indications, prescribing, order review, preparation, administration, and monitoring. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.
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Affiliation(s)
- M Petrea Cober
- Neonatal Intensive Care Unit, Akron Children's Hospital, Akron, Ohio, USA.,College of Pharmacy, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kathleen M Gura
- Pharmacy Clinical Research Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.,Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Jay M Mirtallo
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.,College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Phil Ayers
- Clinical Pharmacy Services, Department of Pharmacy, Baptist Medical Center, Jackson, Mississippi, USA
| | - Joseph Boullata
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Chan B, Lian A, Baer V, Robinson M, Ou Z, Presson AP, Zinkhan EK. An Evaluation to Establish the Acceptable Serum Triglyceride Levels in Neonates Receiving Intravenous Fat Emulsion Infusion in a Multicenter Retrospective Study. Am J Perinatol 2021; 38:e92-e101. [PMID: 32120418 PMCID: PMC10649198 DOI: 10.1055/s-0040-1705174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to establish neonatal serum triglyceride (TG) level reference ranges during lipid infusion and correlate peak TG with neonatal outcomes. STUDY DESIGN This is a retrospective review of 356 neonates with 696 TG measures obtained in four neonatal intensive care units between 2015 and 2017. TG was evaluated collectively to establish a reference range and a threshold limit. To analyze the effects of a higher TG threshold, neonates were categorized by their peak TG: <180 (TG<180), 180 to 400 (TG180-400), and > 400 mg/dL (TG>400). Univariable and multivariable regression models were constructed to compare peak TG to patient characteristic and clinical outcomes. RESULTS The frequency of TG > 400 mg/dL was 5% and found only in neonates weighing < 1.5 kg. Neonates in the TG180-400 (n = 91) group were significantly lower in birth weight and gestational age, had lower 5-minute APGAR scores, and had increased ventilatory requirement when compared with neonates in the TG<180 (n = 240) group (all p < 0.001). The TG180-400 group had increased risk of severe intraventricular hemorrhage (p = 0.02) and bronchopulmonary dysplasia (p = 0.03). Elevated TG was associated with mortality (odds ratio [OR]: 14.4, p < 0.001) in univariable analysis, but the relationship weakened (OR: 4.4, p = 0.05) after adjusting for comorbidities in multivariable logistic regression. CONCLUSION It is unclear if the adverse outcomes seen in neonates with higher peak TG were due to elevated TG alone, or whether illness severity predicted the increased TG. More prospective studies are needed to further delineate the relationships.
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Affiliation(s)
- Belinda Chan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anh Lian
- Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah
| | - Vickie Baer
- Women and Newborn Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Mandy Robinson
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Erin K. Zinkhan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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6
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Rocha G, Guimarães H, Pereira-da-Silva L. The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6245. [PMID: 34207732 PMCID: PMC8296089 DOI: 10.3390/ijerph18126245] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022]
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common severe complication of preterm birth, and nutrition plays a crucial role in lung growth and repair. A practical nutritional approach for infants at risk of BPD or with established BPD is provided based on a comprehensive literature review. Ideally, infants with BPD should receive a fluid intake of not more than 135-150 mL/kg/day and an energy intake of 120-150 kcal/kg/day. Providing high energy in low volume remains a challenge and is the main cause of growth restriction in these infants. They need a nutritional strategy that encompasses early aggressive parenteral nutrition and the initiation of concentrated feedings of energy and nutrients. The order of priority is fortified mother's own milk, followed by fortified donor milk and preterm enriched formulas. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy. Specialized nutritional strategies may be necessary to overcome difficulties common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding. Planning nutrition support after discharge requires a multidisciplinary approach to deal with multiple potential problems. Regular monitoring based on anthropometry and biochemical markers is needed to guide the nutritional intervention.
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Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
| | - Hercília Guimarães
- Department of Neonatology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal;
- Department of Pediatrics, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Luís Pereira-da-Silva
- Comprehensive Health Research Centre (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal;
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
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7
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Ottolini KM, Andescavage N, Limperopoulos C. Lipid Intake and Neurodevelopment in Preterm Infants. Neoreviews 2021; 22:e370-e381. [PMID: 34074642 DOI: 10.1542/neo.22-6-e370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preterm infants are born before the critical period of lipid accretion and brain development that occurs during the third trimester of pregnancy. Dietary lipids serve as an important source of energy and are involved in complex processes that are essential for normal central nervous system development. In addition to traditional neurodevelopmental testing, novel quantitative magnetic resonance imaging (MRI) techniques are now available to evaluate the impact of nutritional interventions on early preterm brain development. Trials of long-chain polyunsaturated fatty acid supplementation have yielded inconsistent effects on neurodevelopmental outcomes and quantitative MRI findings. Recent studies using quantitative MRI suggest a positive impact of early lipid intake on brain volumes and white matter microstructural organization by term-equivalent age.
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Affiliation(s)
- Katherine M Ottolini
- Department of Pediatrics, Division of Neonatology, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nickie Andescavage
- Department of Neonatology and.,Developing Brain Research Laboratory, Children's National Hospital, Washington, DC
| | - Catherine Limperopoulos
- Developing Brain Research Laboratory, Children's National Hospital, Washington, DC.,Departments of Pediatrics and Radiology, George Washington University School of Medicine, Washington, DC
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Mikkonen AT, Martin J, Dourson ML, Hinwood A, Johnson MS. Suggestions for Improving the Characterization of Risk from Exposures to Per and Polyfluorinated Alkyl Substances. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2021; 40:871-886. [PMID: 33201555 DOI: 10.1002/etc.4931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
Many state and federal environmental and health agencies have developed risk-based criteria for assessing the risk of adverse health effects of per- and polyfluorinated alkyl substances (PFAS) exposure to humans and the environment. However, the criteria that have been developed vary; drinking water criteria developed for perfluorooctanoic acid, for example, can vary by up to 750 fold. This is due to differences and variability in the data and information used, study/endpoint selection, assumptions and magnitude of uncertainty factors used in the absence and extrapolation of critical effect data, differences in underlying approaches to addressing exposure within criteria development, and/or policy decisions on levels of acceptable risk. We have critically evaluated the methods used to develop these criteria while focusing on derivation and application of drinking water criteria and discuss a range of improvements to risk-characterization practice recently presented at a Focused Topic Meeting on PFAS conducted by the Society of Environmental Toxicology and Chemistry in Durham, North Carolina, USA, 12 to 15 August 2019. We propose methods that consider maximizing the use of disparate data streams, seeking patterns, and proposing biologically based approaches to evidence integration toward informed criteria development. Environ Toxicol Chem 2021;40:883-898. © 2020 SETAC.
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Affiliation(s)
- Antti T Mikkonen
- University of South Australia Clinical and Health Sciences, Adelaide, South Australia, Australia
- Environment Protection Authority Victoria, Macleod, Victoria, Australia
| | - Jennifer Martin
- Environment Protection Authority Victoria, Macleod, Victoria, Australia
| | | | - Andrea Hinwood
- Environment Protection Authority Victoria, Macleod, Victoria, Australia
| | - Mark S Johnson
- US Army Public Health Center, Aberdeen Proving Ground, Maryland
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9
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Giretti I, D'Ascenzo R, Correani A, Antognoli L, Monachesi C, Biagetti C, Pompilio A, Marinelli L, Burattini I, Cogo P, Carnielli VP. Hypertriglyceridemia and lipid tolerance in preterm infants with a birth weight of less than 1250 g on routine parenteral nutrition. Clin Nutr 2021; 40:4444-4448. [PMID: 33526286 DOI: 10.1016/j.clnu.2020.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the association of hypertriglyceridemia and of lipid tolerance with clinical and nutritional data in preterm infants receiving routine parenteral nutrition. DESIGN We retrospectively studied 672 preterm infants (gestational age <32 weeks) with birth weight <1250 g, consecutively admitted to our NICU, born between 2004 and 2018. Selected prenatal data and interventions, parenteral intakes and diseases were considered. Hypertriglyceridemia was defined as plasma triglycerides >250 mg⋅dL-1. Lipid tolerance was defined as the ratio of plasma triglycerides to the intravenous lipid intake at the time of sampling. Variables associated to hypertriglyceridemia and to lipid tolerance were identified by multiple logistic and linear regression analyses. RESULTS Hypertriglyceridemia occurred in 200 preterm infants (30%), ranging from 67% at 23 weeks to 16% at 31 weeks' gestation. In 138 infants (69%) hypertriglyceridemia occurred at a lipid intake of 2.5 g⋅kg-1 or less. Lipid tolerance was reduced especially in infants of less than 28 weeks' gestation (14.3 ± 9.3 vs 18.8 ± 10.2, respectively, p < 0.001). Lipid tolerance was negatively associated with respiratory distress syndrome (OR = -1.14, p = 0.011), patent ductus arteriosus (OR = -1.73, p < 0.001), small for gestational age (OR = -2.96, p < 0.001), intraventricular haemorrhage (OR = -3.96, p < 0.001), late onset sepsis (OR = -8.56, p = 0.039). CONCLUSION Preterm infants on routine parenteral nutrition were able to tolerate markedly lower intravenous lipid intakes than the recommended target values of current guidelines. Lipid tolerance was associated with some of the major complication of prematurity, possibly at risk of developing hypertriglyceridemia.
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Affiliation(s)
- Ilaria Giretti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy.
| | - Rita D'Ascenzo
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Alessio Correani
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Luca Antognoli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy
| | - Chiara Monachesi
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy
| | - Chiara Biagetti
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Adriana Pompilio
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Luisita Marinelli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Ilaria Burattini
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
| | - Paola Cogo
- Department of Medicine, University of Udine, Udine, Italy
| | - Virgilio P Carnielli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I - G. M. Lancisi - G. Salesi, Ancona, Italy; Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Salesi Children's Hospital, Ancona, Italy
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10
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Bader MY, Lam MA, Munoz F, Thompson L, Kylat RI. Validity of Random Triglyceride Levels in Infants Receiving Parenteral Nutrition. Front Pediatr 2021; 9:601915. [PMID: 34222138 PMCID: PMC8247567 DOI: 10.3389/fped.2021.601915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Intravenous lipid emulsions (IL) are an important part of parenteral nutrition (PN) to meet essential fatty acid (EFA) requirements and metabolic demands of neonates and preterm infants. Some critically-ill neonates may not metabolize IL effectively which can lead to hypertriglyceridemia. Risks associated with this include increased pulmonary vascular resistance, displaced bilirubins, and platelet or macrophage dysfunction. Serum triglyceride (TG) concentration is used as a marker for lipid tolerance and predictor of potential complications involved with IL administration, but the clinical significance of this is still debated. Management of TG levels with regard to timing of laboratory tests, the ideal goal range, and duration of infusion of IL varies across institutions and is not standardized. Methods: Single-center, retrospective study of newborn infants receiving parenteral nutrition (PN). Fasting and non-fasting TG levels were drawn during the same lipid infusion of 2-3g/kg/day. The primary outcome was the difference between fasting and non-fasting TG levels. Statistical assessment of continuous data was done with student t-test and nominal data was evaluated using X2-test and logistic regression. Results: Forty infants were included with mean gestational age at birth of 29.5 ± 3.4 weeks and mean birth weight of 1.3 ± 0.5 kg. Mean time between lab draws while on same IL dose was 11.6 ± 0.2 h with resulting mean fasting and non-fasting (random) TG levels 82 ± 40 mg/dL (95% CI 68.4, 97.6) and 101 ± 40 mg/dL (95% CI 88.5, 115.8), respectively. Mean difference between TG levels during lipid-free interval and during infusion was -18.6 ± 51.2 mg/dL (95% CI -35.0, -2.3; p = 0.03). Conclusion: We concluded there is no difference in the management of IL, when TG level was drawn randomly or as fasting sample. Obtaining TG level during routine lab draws is appropriate. We extrapolated that the administration of IL over 24 h will not interfere with TG level.
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Affiliation(s)
- Mohammad Y Bader
- Department of Pediatrics, University of Arizona Health Sciences, Tucson, AZ, United States.,Banner University Medical Center, Tucson, AZ, United States
| | - Melanie A Lam
- College of Pharmacy, University of Arizona, Tucson, AZ, United States
| | - Fernando Munoz
- Department of Pediatrics, University of Arizona Health Sciences, Tucson, AZ, United States.,Banner University Medical Center, Tucson, AZ, United States
| | | | - Ranjit I Kylat
- Department of Pediatrics, University of Arizona Health Sciences, Tucson, AZ, United States.,Banner University Medical Center, Tucson, AZ, United States
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11
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Shi J, Wang W, Sang G, Xi H, Sun Y, Lu C, Ye H, Huang L. Short Term Usage of Omega-3 Polyunsaturated Fatty Acids Ameliorate Lipopolysaccharide-Induced Inflammatory Response and Oxidative Stress in the Neonatal Rat Hippocampal Tissue. Front Nutr 2020; 7:572363. [PMID: 33282898 PMCID: PMC7705230 DOI: 10.3389/fnut.2020.572363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: To investigate the effect of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on lipopolysaccharide (LPS)-induced inflammatory response and oxidative stress in neonatal rat brain. Methods: Ninety-six 3-day-old Sprague Dawley rats were divided into four groups: control (saline/saline), LPS/ω-3, LPS/ω-6, and LPS/saline (n = 24/group). All rats, except those in the control group, were intraperitoneally challenged once with LPS (0.6 mg/kg) and were treated with ω-3 PUFAs, ω-6 PUFAs, or saline at 15 mL/kg for 1 or 5 consecutive days beginning on the day of LPS-challenge. Rats in the control group underwent the same procedures and received saline (vehicle). After 1 or 5 days of treatment, 12 rats from each group were sacrificed and their hippocampuses were collected. The expression of inflammation-related genes as well as the levels of oxidative stress markers in hippocampal tissues were determined. Results: After 1 or 5 days of treatment, the expression of toll-like receptor 4 and multiple proinflammatory cytokines were significantly decreased in the LPS/ω-3 group compared with those in the LPS/saline group. The activities of superoxide dismutase and glutathione (GSH) were significantly elevated, whereas amounts of malondialdehyde and oxidized glutathione (GSSG) and the ratio of GSSG/GSH were remarkably lowered in the LPS/ω-3 group compared with those in the LPS/saline group after 1 day of treatment. Opposite effects were observed in the LPS/ω-6 group. Conclusion: ω-3 PUFAs may protect rat brain tissue against LPS-induced inflammatory response and oxidative stress.
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Affiliation(s)
- Jipeng Shi
- Henan Key Laboratory of Neurorestoratology, Department of Neonatology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Weiwei Wang
- Henan Key Laboratory of Neurorestoratology, Department of Neonatology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Guimei Sang
- Henan Key Laboratory of Neurorestoratology, Department of Neonatology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Huifang Xi
- Henan Key Laboratory of Neurorestoratology, Department of Neonatology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Yazhou Sun
- Henan Key Laboratory of Neurorestoratology, Department of Neonatology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Chaosheng Lu
- The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China
| | - Hezhen Ye
- The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China
| | - Limi Huang
- The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, China
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Lee MS, Huang YC, Lee CH, Chen HN, Hsiao CC, Huang SC. Implementation of nutrition practice improves growth velocity and weight gain in premature infants ≤ 1250 grams. Pediatr Neonatol 2020; 61:534-541. [PMID: 32622638 DOI: 10.1016/j.pedneo.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The concept of parental nutritional care for premature infants has been applied and advanced over the past decade. This study compared the clinical outcomes before and after nutrition practice (NP) implementation and evaluated the effects of implementation on growth velocity and weight gain in premature infants. METHODS Descriptive data of premature infants (gestational age < 30 weeks; body weight ≤ 1250 g) born 4 years before and after NP implementation were retrospectively reviewed in a neonatal intensive care unit at a hospital in Taiwan. Nutrient intake, growth velocity, weight gain, and nutrition-related biochemical markers were compared at weeks 1, 2, and 4 after delivery. RESULTS A total of 77 premature infants were enrolled before NP implementation (non-NP group), whereas 89 were enrolled after implementation (NP group). The non-NP group consumed less fat and energy in week 1, and less protein, fat, and energy in weeks 2 and 4 compared with the NP group. Growth velocity was slower in the non-NP group. Fat intake was significantly positively correlated with body weight at week 4 in the non-NP group. However, protein and fat intake were significantly associated with body weight at week 1, fat and energy intakes were significantly associated with body weight at week 2, and fat intake was significantly associated with body weight at week 4 in the NP group. CONCLUSION These findings indicate that the NP implemented in this study is relatively safe and can improve growth velocity and body weight gain in premature infants.
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Affiliation(s)
- Ming-Sheng Lee
- Department of Pediatric Pulmonology and Critical Care, Changhua Christian Children Hospital, Changhua, 50050, Taiwan; Graduate Program in Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Yi-Chia Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Cheng-Han Lee
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan
| | - Hsiao-Neng Chen
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan
| | - Chien-Chou Hsiao
- Division of Neonatal Medicine, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, 50050, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan; School of Medicine, Kaohsiung Medical University, 80708, Taiwan
| | - Shih-Chien Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, 40201, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan.
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Ottolini KM, Andescavage N, Kapse K, Jacobs M, Murnick J, VanderVeer R, Basu S, Said M, Limperopoulos C. Early Lipid Intake Improves Cerebellar Growth in Very Low-Birth-Weight Preterm Infants. JPEN J Parenter Enteral Nutr 2020; 45:587-595. [PMID: 32384168 DOI: 10.1002/jpen.1868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite recent advances in nutrition practice in the neonatal intensive care unit, infants remain at high risk for growth restriction following preterm birth. Additionally, optimal values for macronutrient administration, especially lipid intake, have yet to be established for preterm infants in the extrauterine environment. METHODS We studied preterm infants born at very low-birth weight (VLBW, <1500 g) and ≤32 weeks' gestation. Cumulative macronutrient (carbohydrate, lipid, protein, energy) intake in the first 2 and 4 weeks of life was compared with total and regional brain volumes on magnetic resonance imaging (MRI) obtained at term-equivalent age. Preterm infants had no structural brain injury on conventional MRI. RESULTS In a cohort of 67 VLBW infants, cumulative lipid intake in the first 2 weeks of life was positively associated with significantly greater cerebellar volume (β = 95.8; P = .01) after adjusting for weight gain, gestational age at birth, and postmenstrual age at MRI. Cumulative lipid (β = 36.1, P = .01) and energy (β = 3.1; P = .02) intake in the first 4 weeks of life were both significantly associated with greater cerebellar volume. No relationship was seen between carbohydrate or protein intake in the first month of life and cerebral volume at term-equivalent age. CONCLUSION Early cumulative lipid intake in the first month of life is associated with significantly greater cerebellar volume by term-equivalent age in very premature infants. Our findings emphasize the importance of early, aggressive nutrition interventions to optimize cerebellar development in VLBW infants.
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Affiliation(s)
- Katherine M Ottolini
- Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland, USA
| | - Nickie Andescavage
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kushal Kapse
- Developing Brain Research Laboratory, Children's National Hospital, Washington, District of Columbia, USA
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, Children's National Hospital, Washington, District of Columbia, USA
| | - Jonathan Murnick
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Rebecca VanderVeer
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sudeepta Basu
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Mariam Said
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Catherine Limperopoulos
- Developing Brain Research Laboratory, Children's National Hospital, Washington, District of Columbia, USA
- Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia, USA
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Stramara L, Hernandez L, Bloom BT, Durham C. Development of Parenteral Nutrition-Associated Liver Disease and Other Adverse Effects in Neonates Receiving SMOFlipid or Intralipid. JPEN J Parenter Enteral Nutr 2020; 44:1530-1534. [PMID: 32027047 DOI: 10.1002/jpen.1774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravenous lipid emulsions (ILEs) are a risk factor for parenteral nutrition-associated liver disease (PNALD) in the neonatal population. Current literature supports the use of SMOFlipid (4-oil ILE), a fish oil-containing lipid emulsion, for the reversal of PNALD. However, there is little information about the use of 4-oil ILEs for preventing PNALD. The purpose of this study is to examine the safety of a 4-oil ILE in neonates and its effectiveness in preventing PNALD among neonates compared with Intralipid (a soybean-oil, SO-ILE). METHODS This is an observational, cohort, comparative safety study, conducted in a level III neonatal intensive care unit. Participants include neonates who received a 4-oil ILE in their parenteral nutrition (PN) formula, who were matched with historical data of patients who received an SO-ILE, in a 1:3 fashion (4-oil ILE:SO-ILE). The primary outcome of this study is the presence of PNALD (defined as direct bilirubin > 2 mg/dL) after initiation of PN. RESULTS A total of 1332 participants (333 4-oil ILE vs 999 SO-ILE) were included in the data analysis, and PNALD was found to occur in 1.8% of patients in the 4-oil ILE group and 3.6% of patients in the SO-ILE group (Relative risk (RR) 0.5; 95% CI, 0.21-1.18). CONCLUSION The decrease in the incidence of PNALD among the 4-oil ILE group compared with the SO-ILE group indicates a 4-oil ILE may have a hepatoprotective effect.
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Affiliation(s)
| | | | - Barry T Bloom
- Wichita Medical Research and Education Foundation, Wichita, Kansas, USA
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15
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Abdou RM, Weheiba HMI. The effect of early versus late lipid infusion in parenteral nutrition on the biochemical and cortical auditory evoked potential parameters in preterm neonates. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2019. [DOI: 10.1186/s43054-019-0006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
As brain activity depends greatly on the functions provided by lipid membranes, dietary fat in early life can affect the developing nervous system. Despite the adoption of an early more aggressive parenteral nutrition approach with amino acid infusions still reluctance to the early use of intravenous lipids in neonates.
Aim
To compare the effect of delayed versus early introduction of intravenous lipid in preterm on the biochemical parameters and on brain development by the cortical auditory evoked potential (CAEP) latency and amplitude.
Methods
This is a comparative study included 49 neonates admitted at the ain shams university NICUs. Participants were divided into two groups: 26 in group of early lipid infusion and 23 in late lipid infusion, Demographic data, and biochemical parameters were documented during the 1st 2 weeks of life. The CAEP was performed at age of 6 months. The latency and amplitude of P1 were recorded and compared between both groups.
Results
In the present work we found that group of early lipid infusion had reach their full oral intake earlier with shorter duration of parenteral nutrition and length of stay. They had better weight gain and significantly better glucose level control than group of late lipid infusion. There was no significant difference in the other chemical parameters between both groups expect for the higher incidence of cholestasis in the group of late lipid infusion. At 6 months of age, the group of early lipid infusion had significantly shorter latency and amplitude of P1 than the group of late lipid infusion.
Conclusion
Early effective nutrition positively affect feeding tolerance and weight gain and maturation of higher brain centers brain.
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Hegyi T, Kleinfeld A, Huber A, Weinberger B, Memon N, Joe Shih W, Carayannopoulos M, Oh W. Effects of soybean lipid infusion on triglyceride and unbound free fatty acid levels in preterm infants. J Matern Fetal Neonatal Med 2019; 32:3226-3231. [PMID: 29618229 PMCID: PMC6551293 DOI: 10.1080/14767058.2018.1461827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Objective: To determine the plasma triglyceride (TG) and unbound free fatty acid (FFAu) levels in infants treated with increasing dosages of soybean lipid, intralipid (IL), infusion. Study design: TG and FFAu levels were measured in 78 preterm infants (BW 500-2000 g; GA 23-34 weeks) using the fluorescent probe ADIFAB2 and enzymatic method. Results: The infants' BW was 1266.2 ± 440.7 g and GA 28.8 ± 3.1 weeks. TG levels were 77.4 ± 50 mg/dL, 140.2 ± 188 mg/dL (p < .04 compared to levels during low dose IL infusion) and 135.6 ± 118 mg/dL (p < .004), respectively during increased IL rates. FFAu levels were 17.7 ± 13 nM, 47.3 ± 102.8 nM (p = .07) and 98 ± 234 nM (p = .03). TG levels correlated with IL dose, the rate of IL administration, and FFAu levels. TG and FFAu levels were higher in infants below 28 weeks' gestation Conclusions: Increasing dosage of IL is associated with increasing levels of TG and FFAu, especially in infants below 29 weeks of gestation. The increased level of FFAu suggests inefficient cellular utilization.
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Affiliation(s)
- Thomas Hegyi
- a Department of Pediatrics , Robert Wood Johnson Medical School, Rutgers, State University of New Jersey , New Brunswick , NJ , USA
| | | | | | - Barry Weinberger
- c Department of Pediatrics , Cohen Children's Medical Center, Northwell Health , New Hyde Park , NY , USA
| | - Naureen Memon
- d MidAtlantic Neonatology Ass. Goryeb Children's Hospital , Morristown , NJ , USA
| | - Weichung Joe Shih
- e Rutgers School of Public Health , Rutgers University , New Brunswick , NJ , USA
| | - Mary Carayannopoulos
- f Department of Pathology and Laboratory Medicine , Robert Wood Johnson Medical School, Rutgers, the State University of New Jersey , New Brunswick , NJ , USA
| | - William Oh
- g Department of Pediatrics , Alpert Medical School of Brown University , Providence , RI , USA
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Amran MHH, Zulfakar MH, Danik MF, Abdullah MSP, Shamsuddin AF. A new alternative for intravenous lipid emulsion 20% w/w from superolein oil and its effect on lipid and liver profiles in an animal model. ACTA ACUST UNITED AC 2019; 27:191-201. [PMID: 31020546 DOI: 10.1007/s40199-019-00262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/08/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Intravenous lipid emulsion (IVLE) was first used to prevent essential fatty acids deficiency. IVLE with α-tocopherol was reported to provide protection against parenteral nutrition-associated liver disease. This study aims to determine the optimal parameters and conditions in developing a physically stable IVLE from superolein palm oil (SoLE 20%) and its effect on lipid and liver profiles in an animal model. METHODS SoLE 20% was prepared using superolein oil and MCT oil (1:1), stabilized with egg lecithin and homogenized using a high pressure homogenizer. Mean droplet size was used as the response variable and was measured using laser diffraction and dynamic light scattering method. Physical stability at 4 °C, 25 °C and 40 °C storage temperatures were determined based on particle size and distribution, polydispersity index, zeta potential, viscosity, vitamin E contents and pH. Sterility and pyrogenicity were also investigated. Rabbits were administered with 1.0 g/kg SoLE 20% for 5 h and repeated daily for 3 days to investigate its effect on blood lipid and liver enzymes profile. RESULTS SoLE 20% was succesfully prepared using the optimized parameters of 800 psi, 7 cycles and 1.2 g lecithin. The IVLE prepared had a particle size of 252.60 ± 4.88 nm and was physically stable for 4 weeks at different storage temperatures. SoLE 20% had a high content of natural vitamin E, remained sterile and pyrogen free. It was also safe for intravenous administration and did not alter the blood lipid (p > 0.05) and liver enzymes profiles (p > 0.05) of the rabbits. CONCLUSION The optimal parameters to develop a stable superolein based IVLE are 800 psi homogenization pressure, 7 homogenization cycles and using 1.2 g lecithin as the emulsifier. SoLE 20% is safe for intravenous administration and does not significantly alter lipid and liver enzymes profiles of the rabbits.
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Affiliation(s)
- Mohd Haz Hairul Amran
- Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Parenteral Nutrition Unit, Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohd Hanif Zulfakar
- Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Fairuz Danik
- Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Shakrie Palan Abdullah
- Department of Pharmacy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,Pharmacy Service Division - Enforcement Pharmacy, Kelantan State Health Department, Kota Bharu, Kelantan, Malaysia
| | - Ahmad Fuad Shamsuddin
- Centre for Drug Delivery Research, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. .,Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine, No. 3, Jalan Greentown, 30450, Ipoh, Perak, Malaysia.
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18
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Stability of commercial parenteral lipid emulsions repacking to polypropylene syringes. PLoS One 2019; 14:e0214451. [PMID: 30970011 PMCID: PMC6457611 DOI: 10.1371/journal.pone.0214451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
To accommodate small fluid volumes, repackaging of intravenous lipid emulsions is frequently performed in hospitals providing parenteral nutrition to neonates and smaller pediatric patients. The physical stability of lipid commercial parenteral emulsions repacked and stored in polypropylene syringe up to 30 days at room temperature, refrigerator and 40°C was determined to establish options for extended storage. Lipid emulsions in the manufacturers’ original containers were used as references. Commercial lipid emulsions (20% of oil phase), ClinOleic, Intralipid, Smoflipid, Omegaven and Lipofindin LCT/MCT were repackaged under aseptic conditions in polypropylene syringes and stored at 4°C, 25°C and 40°C without light protection. Samples were assayed periodically over 30 days using validated, stability-indicating methods. Lipid emulsions in the manufacturers’ containers stored in the same conditions were as references. Analysis of variance showed differences in the physical parameters due to temperature (p<0.05) and study day (p<0.05) but not the type of the emulsion (p = 0.98). The parenteral lipid emulsions in polypropylene syringe exhibited identical (except Z-avarage at 40°C, t = 30 days) to original containers time-dependent behavior taking into account the mean globule size, pH, and zeta potential measurements. Size of oily droplets of all test conditions remained below the United States Pharmacopeia limits. The results allow safe repacking of commercial lipid emulsion in a syringe, which is a necessary condition for supplying parenteral nutrition using the two-in-one method for newborns. However, longer storage than 12 h of repacked emulsion needs microbiological studies.
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19
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Repa A, Pablik E. Reply. J Pediatr 2019; 207:260-261. [PMID: 30679054 PMCID: PMC7239669 DOI: 10.1016/j.jpeds.2018.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Andreas Repa
- Medical University of Vienna; Department of Pediatrics, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics; Waehringer Guertel 18-20; 1090 Vienna, Austria
| | - Eleonore Pablik
- Medical University of Vienna; Section for Medical Statistics, CeMSIIS; Waehringer Guertel 18-20; 1090 Vienna, Austria
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20
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Gramlich L, Ireton-Jones C, Miles JM, Morrison M, Pontes-Arruda A. Essential Fatty Acid Requirements and Intravenous Lipid Emulsions. JPEN J Parenter Enteral Nutr 2019; 43:697-707. [PMID: 30908685 DOI: 10.1002/jpen.1537] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
Abstract
Linoleic acid (LA) and α-linolenic acid (ALA) must be supplied to the human body and are therefore considered essential fatty acids. This narrative review discusses the signs, symptoms, diagnosis, prevention, and treatment of essential fatty acid deficiency (EFAD). EFAD may occur in patients with conditions that severely limit the intake, digestion, absorption, and/or metabolism of fat. EFAD may be prevented in patients requiring parenteral nutrition by inclusion of an intravenous lipid emulsion (ILE) as a source of LA and ALA. Early ILEs consisted solely of soybean oil (SO), a good source of LA and ALA, but being rich in LA may promote the production of proinflammatory fatty acids. Subsequent ILE formulations replaced part of the SO with other fat sources to decrease the amount of proinflammatory fatty acids. Although rare, EFAD is diagnosed by an elevated triene:tetraene (T:T) ratio, which reflects increased metabolism of oleic acid to Mead acid in the absence of adequate LA and ALA. Assays for measuring fatty acids have improved over the years, and therefore it is necessary to take into account the particular assay used and its reference range when determining if the T:T ratio indicates EFAD. In patients with a high degree of suspicion for EFAD, obtaining a fatty acid profile may provide additional useful information for making a diagnosis of EFAD. In patients receiving an ILE, the T:T ratio and fatty acid profile should be interpreted in light of the fatty acid composition of the ILE to ensure accurate diagnosis of EFAD.
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Affiliation(s)
- Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | | | - John M Miles
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maya Morrison
- Baxter Healthcare Corporation, Deerfield, Illinois, USA
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Abstract
BACKGROUND Patients with gastroschisis and prolonged total (or partial) parenteral nutrition (PN) commonly develop direct hyperbilirubinemia (DH). OBJECTIVE To quantify the prevalence and severity of DH in newborns with gastroschisis and characterize the diagnostic work-up for DH in this patient population. DESIGN/METHODS Retrospective chart review of patients born with gastroschisis between 2005 and 2015 for the first 6 months of life. RESULTS 29 patients were identified with gastroschisis. Mean gestational age and birthweight were 36.4 (± 1.8) weeks and 2.5 (± 0.6) kg. 41% were treated with primary reduction versus staged closure. Peak total and direct bilirubin (DB) levels were 10.17 ± 6.21 mg/dL and 5.58 ± 3.94 mg/dL, respectively. 23 patients (79.3%) were diagnosed with DH and 78.2% underwent additional work-up for hyperbilirubinemia consisting of imaging and laboratory studies, none of which revealed a cause for DH other than the presumed PN-associated cholestasis. In all patients, DB began to decline within 1-10 days of initiation of enteral feeds. CONCLUSION(S) DH is common in patients with gastroschisis and is unlikely to be associated with pathology aside from PN. Additional work-up may lead to unnecessary resource utilization. LEVELS OF EVIDENCE Case series with no comparison group, Level IV.
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Hypertriglyceridaemia in extremely preterm infants receiving parenteral lipid emulsions. BMC Pediatr 2018; 18:348. [PMID: 30404604 PMCID: PMC6220513 DOI: 10.1186/s12887-018-1325-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lipid emulsions (LE) are routinely administered as part of parenteral nutrition in neonates. There is a wide variation in clinical practice of plasma triglyceride monitoring during LE therapy. Our aim was to evaluate the incidence of hypertriglyceridaemia (Plasma triglyceride > 2.8 mmol/L) and its association with mortality and major morbidities in extremely preterm infants on parenteral nutrition. Methods A retrospective review of 195 infants < 29 weeks gestation. Lipid emulsion was commenced at 1 g/kg/day soon after birth and increased by 1 g/kg daily up to 3 g/kg/day and continued until the infant was on at least 120 ml/kg/day of enteral feeds. Plasma triglyceride concentrations were measured at each increment and the lipid emulsion dosage was adjusted to keep plasma triglyceride concentrations ≤2.8 mmol/L. Results Hypertriglyceridemia was noted in 38 neonates (32.5% in 23–25 weeks and 16.1% in 26–28 weeks). Severe hypertriglyceridemia (> 4.5 mmol/L) was noted in 11 infants (10.0% in 23–25 weeks and 4.5% in 26–28 weeks). Hypertriglyceridemia was associated with an increase in mortality (unadjusted OR 3.5; 95% CI 1.13–10.76; 0.033) and severe retinopathy of prematurity (unadjusted OR 4.06; 95% CI 1.73–9.59; 0.002) on univariate analysis. However, this association became non-significant in multivariate analysis with adjustment for gestation and birthweight. Conclusions Hypertriglyceridemia is common in extremely preterm infants receiving parenteral lipid emulsions. Regular monitoring and prompt adjustment of lipid intake in the presence of hypertriglyceridemia, minimising the length of exposure to hypertriglyceridemia, may mitigate potential consequences.
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Kapoor V, Malviya MN, Soll R. Lipid emulsions for parenterally-fed term and late preterm infants. Hippokratia 2018. [DOI: 10.1002/14651858.cd013171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vishal Kapoor
- Queensland Children's Hospital; Department of Paediatrics; 501 Stanley Street Brisbane Queensland Australia 4101
| | - Manoj N Malviya
- Khoula Hospital; Neonatal Intensive Care Unit; Muscat Muscat Oman
| | - Roger Soll
- Larner College of Medicine at the University of Vermont; Division of Neonatal-Perinatal Medicine, Department of Pediatrics; 111 Colchester Avenue Burlington Vermont USA 05401
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Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to compare the effectiveness and safety of lipid formulations from different sources, including soybean oil‐based, multicomponent, olive oil‐based, and fish oil–based, in parenterally fed preterm infants. The secondary objective is to determine the effectiveness and safety of alternative lipid emulsions compared with soybean oil‐based lipid emulsions in relation to gestational age (less than 30 weeks' gestation; 30 weeks' gestation or more), birth weight (1000 grams or less; more than 1000 grams), clinical condition (surgical patients, patients with established cholestasis).
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Affiliation(s)
- Vishal Kapoor
- Queensland Children's HospitalDepartment of Paediatrics501 Stanley StreetBrisbaneAustralia4101
| | | | - Roger Soll
- Larner College of Medicine at the University of VermontDivision of Neonatal‐Perinatal Medicine, Department of Pediatrics111 Colchester AvenueBurlingtonUSA05401
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Suganuma H, Ikeda N, Ohkawa N, Shoji H, Shimizu T. Influence of i.v. lipid emulsion on lipoprotein subclass in preterm infants. Pediatr Int 2018; 60:839-843. [PMID: 29931721 DOI: 10.1111/ped.13643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Lipid emulsions given i.v. are normally rapidly metabolized by apoprotein recruited from high-density lipoprotein (HDL) particles in the blood. Very low-birthweight infants (VLBWI), however, have a low rate of lipid clearance from the blood, and therefore lipid emulsions must be given carefully to minimize the risk of hyperlipidemia. The purpose of this study was to evaluate the influence of i.v. lipid emulsion on lipoprotein subclass profile in VLBWI during the early postnatal period. METHODS Forty-six VLBWI who had been given different doses of lipid emulsion in the first few days after birth were enrolled in the present study. Triglyceride and cholesterol content of each lipoprotein subclass was measured at 3 weeks after birth, and their correlation with the total dose of lipid emulsion was calculated. RESULTS There was no correlation between the total dose of lipid emulsion and the triglyceride and cholesterol content in any subclasses of very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL). There was a significant negative correlation between the total dose of lipid emulsion and the triglyceride content in very large (P < 0.05, r = -0.32), large (P < 0.01, r = -0.47) and medium HDL (P < 0.05, r = -0.34) particles; and the cholesterol content in large (P < 0.01, r = -0.47) and medium HDL (P < 0.01, r = -0.4) particles. CONCLUSION Lipid emulsion influenced the triglyceride and cholesterol content of HDL particles in VLBWI, suggesting that lipid emulsion can affect lipid metabolism in this infant population in the early postnatal period.
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Affiliation(s)
- Hiroki Suganuma
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Naho Ikeda
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Natsuki Ohkawa
- Neonatal Care Center, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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26
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Lenhartova N, Matasova K, Lasabova Z, Javorka K, Calkovska A. Impact of early aggressive nutrition on retinal development in premature infants. Physiol Res 2018; 66:S215-S226. [PMID: 28937236 DOI: 10.33549/physiolres.933677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The normal retinal development is interrupted by preterm birth and a retinopathy of prematurity (ROP) may develop as its consequence. ROP is characterized by aberrant vessel formation in the retina as a response to multiple risk factors influencing the process of retinal angiogenesis. Insulin-like growth factor I (IGF-1) and vascular endothelial growth factor (VEGF) play an important role in the process of normal retinal vascularization. Insufficient nutrition during the first 4 postnatal weeks results in low serum levels of IGF-1, which is essential for correct retinal vessels formation, ensuring survival of the newly formed endothelial cells. Low IGF-1 level results in stop of angiogenesis in the retina, leaving it avascular and prompting the onset of ROP. Keeping the newborns in a positive energetic balance by providing enough nutrients and energy has a beneficial impact on their growth, neurodevelopment and decreased incidence of ROP. The best way to achieve this is the early parenteral nutrition with the high content of nutrients combined with early enteral feeding by the own mother´s breast milk. Multiple studies confirmed the safety and efficacy of early aggressive nutrition but information about its long-term effects on the metabolism, growth and development is still needed.
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Affiliation(s)
- N Lenhartova
- Clinic of Neonatology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital, Martin, Slovakia.
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27
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Khasawneh W, Bani Hani S. Intravenous Lipid Emulsion Overdose in Infancy: A Case Report and Overview of Opportunities, Challenges and Prevention. DRUG SAFETY - CASE REPORTS 2018; 5:13. [PMID: 29556886 PMCID: PMC5859004 DOI: 10.1007/s40800-018-0079-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Medication errors remain among the major problems seen in hospitals. Such errors can relate to the prescription, dispensation, or administration of drugs. Human factors account for most of these mistakes, but other factors such as infusion pump programming defects should always be considered. Worldwide, medication errors have been reported to affect 2-30% of patients, depending on the institution. Intravenous lipid emulsion (ILE) infusion is frequently used as part of total parenteral nutrition in patients of all ages with feeding and gastrointestinal issues. ILE overdose has been previously reported, with variable clinical outcomes. We report a case of accidental ILE (Intralipid) overdose in a 3-month-old male infant who fully recovered after single-volume blood exchange transfusion. We also review reported cases and summarize potential solutions for ILE overdose. Our review indicates that ILE infusion is a high-risk medication, and opportunities for errors remain even in the best hospital set-ups. Attention should be directed towards proper prescription, dosing, dispensation, and administration. Most of the cases indicate the safety breach was at the nursing drug-administration level, with improper pump use or programming, together with other fluid infusion rate switching, being the main possible defects. Strategies targeting the areas of weakness in the drug-delivery pathway are needed. Special attention should be paid towards nursing duties and working hours. In addition, nursing staff should receive frequent education sessions and should be required to pass competency modules regularly. An error-prevention plan should be established and implemented. This plan needs full collaboration between physicians, pharmacists, and nursing staff.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
| | - Salar Bani Hani
- Department of Pediatrics, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan
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28
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Riera P, Garrido-Alejos G, Cardenete J, Moliner E, Zapico-Muñiz E, Cardona D, Garin N. Physicochemical Stability and Sterility of Standard Parenteral Nutrition Solutions and Simulated Y-Site Admixtures for Neonates. Nutr Clin Pract 2018; 33:694-700. [DOI: 10.1002/ncp.10013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/11/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Pau Riera
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
- Faculty of Pharmacy and Food Sciences; Universitat de Barcelona; Barcelona Spain
| | - Gemma Garrido-Alejos
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Joana Cardenete
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Elisenda Moliner
- Neonatal Unit; Department of Paediatrics; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Edgar Zapico-Muñiz
- Clinical Biochemistry Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Daniel Cardona
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Noe Garin
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
- Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red de Salud Mental; Madrid Spain
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29
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Pereira-da-Silva L, Nóbrega S, Rosa ML, Alves M, Pita A, Virella D, Papoila AL, Serelha M, Cordeiro-Ferreira G, Koletzko B. Parenteral nutrition-associated cholestasis and triglyceridemia in surgical term and near-term neonates: A pilot randomized controlled trial of two mixed intravenous lipid emulsions. Clin Nutr ESPEN 2017; 22:7-12. [PMID: 29415837 DOI: 10.1016/j.clnesp.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/07/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cholestasis is a common complication in infants receiving prolonged parenteral nutrition (PN). We studied the effects of two intravenous lipid emulsions composed with either 30% soybean oil, 30% medium-chain triglycerides (MCT), 25% olive oil, and 15% fish oil (SMOF) or with 50% MCT and 50% soybean oil n-6 (MCT/SOY) on the incidence of cholestasis in surgical term and near-term neonates. METHODS A single-center, double-blinded, randomized controlled trial compared the incidence of cholestasis using either SMOF or MCT/SOY in neonates born at gestational age ≥34 weeks undergoing major surgery. The primary outcome was the incidence of conjugated serum bilirubin >1 mg/dL. Other liver enzymes were assessed as secondary outcomes. A post-hoc analysis assessed serum triglycerides levels. Odds ratios were estimated by mixed-effects regression models. RESULTS Enrollment was prematurely interrupted because the MCT/SOY became unavailable, thus 49 infants (SMOF 22, MCT/SOY 27) completed the study. The exposure (time on PN, cumulative dose of lipids) was similar in both groups. Similar cumulative incidence rates were found for elevated conjugated bilirubinemia and other liver enzymes. Hypertriglyceridemia >250 mg/dL (12/49) was more frequent in MCT/SOY (37.0%, 95% CI 21.53-55.77) than in SMOF (9.1%, 95% CI 2.53-27.81, p = 0.024). Triglyceridemia at the first assessment (median 8 postnatal days) was significantly higher with MCT/SOY than with SMOF (181 vs. 134 mg/dL, p = 0.006). Over the whole study period, mean triglyceride concentration was 36.5 mg/dL higher with MCT/SOY compared with SMOF (p = 0.013). CONCLUSION Both emulsions had similar effects on the incidence of cholestasis and markers of liver integrity, but MCT/SOY induced higher serum triglyceride concentrations. TRIAL REGISTRATION ClinicalTrials.gov, NCT02633384.
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Affiliation(s)
- Luís Pereira-da-Silva
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
| | - Sara Nóbrega
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Luísa Rosa
- Pharmacy Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Pita
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Daniel Virella
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Research Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Micaela Serelha
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gonçalo Cordeiro-Ferreira
- Neonatal Intensive Care Unit, Woman, Infant and Adolescent Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität München, Division Metabolic Diseases and Nutrition, Department of Pediatrics, Dr. von Hauner Children's Hospital, Univ. of Munich Medical Center, Munich, Germany
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30
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E2F1 Orchestrates Transcriptomics and Oxidative Metabolism in Wharton's Jelly-Derived Mesenchymal Stem Cells from Growth-Restricted Infants. PLoS One 2016; 11:e0163035. [PMID: 27631473 PMCID: PMC5025055 DOI: 10.1371/journal.pone.0163035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022] Open
Abstract
Wharton's jelly-derived Mesenchymal Stem Cells (MSCs) isolated from newborns with intrauterine fetal growth restriction were previously shown to exert anabolic features including insulin hypersensitivity. Here, we extend these observations and demonstrate that MSCs from small for gestational age (SGA) individuals have decreased mitochondrial oxygen consumption rates. Comparing normally grown and SGA MSCs using next generation sequencing studies, we measured global transcriptomic and epigenetic profiles and identified E2F1 as an over-expressed transcription factor regulating oxidative metabolism in the SGA group. We further show that E2F1 regulates the differential transcriptome found in SGA derived MSCs and is associated with the activating histone marks H3K27ac and H3K4me3. One of the key genes regulated by E2F1 was found to be the fatty acid elongase ELOVL2, a gene involved in the endogenous synthesis of docosahexaenoic acid (DHA). Finally, we shed light on how the E2F1-ELOVL2 pathway may alter oxidative respiration in the SGA condition by contributing to the maintenance of cellular metabolic homeostasis.
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31
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Ng DVY, Brennan-Donnan J, Unger S, Bando N, Gibbins S, Nash A, Kiss A, O'Connor DL. How Close Are We to Achieving Energy and Nutrient Goals for Very Low Birth Weight Infants in the First Week? JPEN J Parenter Enteral Nutr 2016; 41:500-506. [PMID: 26160253 DOI: 10.1177/0148607115594674] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emerging evidence suggests intakes of protein and energy as early as the first week of life in preterm very low birth weight (VLBW) infants are associated with improved neurodevelopment. In response, many neonatal intensive care units (NICUs) have launched new, more aggressive early feeding guidelines. The aim of this study was to evaluate enteral and parenteral energy and macronutrient intakes during the first postnatal week in VLBW infants admitted to NICUs that have introduced more aggressive early feeding guidelines. MATERIALS AND METHODS Estimated energy and macronutrient intakes were prospectively collected from VLBW infants fed exclusively mother's own milk and/or parenteral nutrition and compared with expert recommendations. Days to reach full enteral feeds (150 mL/kg/d) and discharge anthropometrics were examined. RESULTS By days 6 and 7, median protein and lipid intakes, respectively, reached recommended values (3.5 and 3.0 g/kg/d). However, by day 8, many infants remained below recommended intakes for protein (34%), lipid (34%), carbohydrate (68%), and energy (71%). Late-onset sepsis was associated with a decreased likelihood of reaching full enteral feeds on any given day (hazard ratio, 0.2; 95% confidence interval, 0.1-0.5; P ≤ .0009). There was no significant relationship between week 1 nutrient intakes and anthropometrics at discharge. CONCLUSION Despite the introduction of more aggressive early feeding guidelines and improved energy and nutrient intakes compared with literature values, many VLBW infants remain below recommended nutrition goals in the first week.
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Affiliation(s)
- Dawn V Y Ng
- 1 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joan Brennan-Donnan
- 3 Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Unger
- 4 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,5 Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,6 Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nicole Bando
- 2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharyn Gibbins
- 7 Department of Professional Practice, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Andrea Nash
- 8 Sunnybrook Health Sciences Center Neonatal Intensive Care Unit, Toronto, Ontario, Canada
| | - Alex Kiss
- 9 Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,10 Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- 1 Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,2 The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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