10/23/2023 0 Comments Iv lipid emulsion therapy indicationsHere, we would like to provide a brief basic overview of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature that can be used as a basis for revising clinical care and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma.įatty acids are categorized according to the number of carbon atoms and the position and number of any double bonds into saturated, monounsaturated, and polyunsaturated fatty acids. 1 – 10 Many dogmas still exist, and appear to be the responsible for not to use 2–3 g/kg/d of intravenous lipids by many neonatologist in VLBW and ELBW infants from the first day of life. Furthermore, there is clear evidence nowadays that fat emulsions can be tolerated well by VLBW and extremely low birth weight (ELBW) infants starting from the first day, and even from the first 1–2 hours of life. In reality, the data for these are nonexistent, misinterpreted, or lacking. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, can displace bilirubin from albumin, can cause central nervous system (CNS) injury, can cause thrombocytopenia, and can exacerbate sepsis. Despite the adoption of a more aggressive approach with amino acid infusions, there is still reluctance to the early use of intravenous lipids. Several recent reviews have focused on intravenous nutrition for premature neonates, but few have provided comprehensive review of intravenous lipid, for very low birth weight (VLBW) neonates, and other critically ill neonates.īased on recent studies in the last few years that were catalyzed by conferences at National Institutes of Health, many centers started to use early more aggressive parenteral nutrition (continuous glucose infusion at a rate of 6–8 mg/kg/day protein 3 mg/kg/day), starting within the first 1–2 hours after birth. Despite vast improvements from the original formulations and optimization by means of administration, considerable confusion remains about optimal usage, and much still needs to be learned, to optimize this form of therapy. The capability to provide intravenous fluids and nutrition, for critically ill neonates, has existed for almost 40 years. Here, we would like to provide a brief basic overview, of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature, that can be used as a basis for revising clinical care, and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma than science. Several recent reviews have focused on intravenous nutrition for premature neonate, but very little exists that provides a comprehensive review of intravenous lipid for very low birth and other critically ill neonates. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, displace bilirubin from albumin, exacerbate sepsis, and cause CNS injury and thrombocytopena. Despite adoption of a more aggressive approach with amino acid infusions, there still appears to be a reluctance to use early intravenous lipids. Parenteral nutrition is needed in these infants because most cannot meet the majority of their nutritional needs using the enteral route. These infants are usually highly stressed and at risk for catabolism. Continuation of this growth in the first several weeks postnatally during the time these infants are on ventilator support and receiving critical care is often a challenge. Extremely low birth weight infants (ELBW) are born at a time when the fetus is undergoing rapid intrauterine brain and body growth.
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