Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 743-751 (doi:10.1542/10.1542/peds.2007-2282)
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ARTICLE

Randomized Trial of Very Low Birth Weight Infants Receiving Higher Rates of Infusion of Intravenous Fat Emulsions During the First Week of Life

Douglas Drenckpohl, MS, RD, CNSD, LDNa, Connie McConnell, RNa, Shirley Gaffney, RNa, Matt Niehaus, PharmDa and Kamlesh S. Macwan, MDb

a Neonatal Intensive Care Unit, Children's Hospital of Illinois at Third Order of Saint Francis Saint Francis Medical Center, Peoria, Illinois
b Section of Neonatology, Department of Pediatrics, University of Illinois, College of Medicine at Peoria, Peoria, Illinois

OBJECTIVE. The goal was to determine whether very low birth weight infants could tolerate higher rates of infusion of intravenous fat emulsion during the first week of life and maintain their serum triglyceride levels at ≤200 mg/dL.

METHODS. This was a randomized, controlled trial of 110 infants who were classified as appropriate for gestational age and had birth weights between 750 g and 1500 g. The primary clinical outcome was serum triglyceride levels; secondary outcomes also were monitored.

RESULTS. One hundred infants completed the study (experimental group: N = 48; control group: N = 52). Infants in the experimental group had significantly higher energy intake for the entire 7-day study period and achieved 90 kcal/kg per day (1 kcal = 4.184 kJ) significantly sooner (7.38 ± 3.381 days vs 9.44 ± 3.578 days). Triglyceride levels for infants in the experimental group remained significantly higher for the first 5 days of life. Fifteen percent of infants in the experimental group but only 4% of infants in the control group developed hypertriglyceridemia. Ten percent of infants in the control group but no infants in the experimental group required insulin therapy. Forty-two percent of infants in the experimental group and 17% of infants in the control group remained at ≥10th percentile for weight for age. Fourteen percent of infants in the control group but no infants in the experimental group developed necrotizing enterocolitis. Twenty-three percent of infants in the control group but only 6% of infants in the experimental group developed retinopathy of prematurity. There were no significant differences in other outcomes.

CONCLUSIONS. Very low birth weight infants can tolerate higher rates of infusion of intravenous fat emulsion solutions during the first week of life without significant adverse events.

Key Words: intravenous fat emulsions • total nutrient admixtures • amino acids

Abbreviations: VLBW—very low birth weight • NEC—necrotizing enterocolitis • AGA—appropriate for gestational age • ROP—retinopathy of prematurity • IVFE—intravenous fat emulsion • TPN—total parenteral nutrition • TNA—total nutrient admixture

Accepted Jan 7, 2008.


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