Associative Tolerance of Intravenously Administered Lipid and Gestational Age in Preterm Infants Receiving Total Parenteral Nutrition

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Associative Tolerance of Intravenously Administered Lipid and Gestational Age in Preterm Infants Receiving Total Parenteral Nutrition

Aim. The aim of this study is to investigate the effect of constant amount of lipid during total parenteral nutrition (TPN), by the evaluation of serum levels of: total cholesterol, triglycerides, free fatty acids, billirubin, AST, ALT, acid base status in the group of sick preterm infants.

Material and methods. The tolerance for intravenously administered lipid (IL), with a maximal daily dose of 2.5 gr/kg, in 20 sick preterm infants during total parenteral nutrition was analyzed by controlling the total serum lipid level; the total cholesterol; the serum triglycerides concentration; the free fatty acids levels; the lipoprotein electrophoresis; the bilirubin level (total, conjugated and unconjugated); ALT and AST; the blood hemoglobin; erythrocyte, leukocyte and reticulocyte count; hematocrit; and the acid base status in capillary, venous and arterial blood.

Results. A serum triglyceride concentration <1.5 mmol/l was found in 15 (75%) out of 20 triglyceride determinations, levels between 1.5-2.0 mmol/l were found in 3 (15%), and >2.0 mmol/l in 2 (10%). Hypertriglyceridemia >1.5 mmol/l was found in 4 patients with perinatal asphyxia and one with septicemia. There is a highly significant inverse correlation (p<0.001) between birth weight, gestational age and serum triglyceride level. The other analysis made for control of lipid tolerance were normal except the lower oxygen saturation levels such as pO2 and increased pCO2, derived from patients with RDSy. An important increase in body weight was signed: 24.948 gr/gr infused protein/24h, 45.528gr/418 KJ energy/24h, 22.078gr/kg body weight/24h.

Conclusion. Our study showed that the intake of 2.5 g/kg/day proteins and 2.5 g/kg/day IL can be tolerated without metabolic or respiratory complications, and can also prevent the development of negative nitrogen balance seen in the conventional management of delivering glucose alone.

Heird WC, Driscoll JM, Shullinger NJ, Grebin B, Winters RW. Intravenous alimentation in paediatric patients, J Pediatr. 1972;80:351-372. doi:10.1016/S0022-3476(72)80492-X PMID:4621870

Clark R, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003;111:986-990. doi:10.1542/peds.111.5.986 PMID:12728076

Bloom BT, Mulligan J, Arnold C, et al. Improving growth of the very-low-birth-weight infants in the first 28-days. Pediatrics. 2003;112:8-14. doi:10.1542/peds.112.1.8 PMID:12837860

Rivera A, Edward F, Bier DN. Effects of intravenous amino acids on protein metabolism of preterm infants during the first three days of life. Int Pediatr Res. 1993;33(2):106-111. doi:10.1203/00006450-199302000-00003 PMID:8433884

Anderson TL, Muttart CR, Bieber MA, et al. A controlled trial of glucose vs glucose and amino acids in premature infants. J Pediatr. 1979;94: 947-951. doi:10.1016/S0022-3476(79)80230-9 PMID:109596

Van Goudoever JB, Wattimena CJ, Colen T, Huijmans JGM, Caranielli VP, Sauer PJJ. Immediate commencement of amino acid supplementation in preterm infants: effect on serum amino acid concentration and protein kinetics on first day of life. J Pediatr. 1995;127: 458-465. doi:10.1016/S0022-3476(95)70083-8 PMID:7658281

Dobbing J. Nutritional growth restrictions and the nervous system, In: Davision AN, Thompson RHS editors. The Molecular Basis of Neuropathology, London: Edward Arnold; 1981 p. 221-233.

Lucas A, Morley R, Cole TJ. Randomized trial of early diet in preterm babies and later intelligence quotient. BMJ. 1998;317(7171):1481-1487. PMID:9831573

Hay Jr. WW, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low-birth-weight infant, Pediatrics. 1999;104:1360-1368. doi:10.1542/peds.104.6.1360 PMID:10585989

Saini JF, McMahon P, Morgan JB, Kovar IZ. Early parenteral feeding of amino acids. Arch Dis Child. 1989;64:1362-1366. doi:10.1136/adc.64.10_Spec_No.1362 PMID:2511809 PMCID:1590101

Gilbertson N, Kovar IZ, Cox DJ, Crow L, Palmer NT. Introduction of intravenous lipid administration of the first day of life in the very-low-birth-weight neonate. J Pediatr. 1991;119: 615-623. doi:10.1016/S0022-3476(05)82416-3 PMID:1919895

Murdock N, Crighton A, Nelson LM, Forsyth JS. Low-birth-weight infants and total parenteral nutrition immediately after birth, II Randomized study of biochemical tolerance of intravenous glucose, amino acids and lipid. Arch Dis Child Fetal Neonatal Ed. 1995;73:F8-F12. doi:10.1136/adc.73.1.8 PMID:7639558 PMCID:1511152

Forsyth JS, Murdock N, Crighton A. Low-birth-weight infants and total parenteral nutrition immediately after birth, III Randomized study of energy substrate utilization, nitrogen balance, and carbon dioxide production. Arch Dis Child Fetal Neonatal Ed. 1995;73(1): F13-F16. PMID:7552589

Auestad N, Halter R, Robert T, et al. Growth and development in term infants fed long-chain polyunsaturated fatty acids: a double-masked, randomized, parellel, prospective, multivariate study. Pediatrics. 2001;108:372-381. doi:10.1542/peds.108.2.372 PMID:11483802

Bourre JM, Francois M, Youyou A, et al. The effects of dietary alpha-linolenic acid on the composition of nerve membranes, enzymatic activity, amplitude of electrophysiological parameters, resistance to poisons and performance of learning tasks in rates. J Nutr. 1989;119(12):1880-1892. PMID:2576038

O'Connor DL, Hall R, Adamkin D, et al. and on behalf of the Ross preterm infants fed long-chain polyunsaturated fatty acids: a prospective randomized controlled trial. Pediatrics. 2001;108:359-371. doi:10.1542/peds.108.2.359 PMID:11483801

Carlson SE, Werkman SH, Tolley EA. The effect of long-chain n-3 fatty acid supplement on visual acuity and growth of preterm infants with and without bronchopulmonary dysplasia. Am J Clin Nutr. 1996;63(5):687-697. PMID:8615350

Auestad N, Scott DT, Janowsky JS, et al. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003;112:177-183. doi:10.1542/peds.112.3.e177 PMID:12949309

ASPEN Board of directors. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patient. JPEN. 2002;26(1):(Supll).

Hambidge KM, Krebs NF. Normal Childhood Nutrition & Its Disorders. In: Hathaway EW, Groothuis RJ, Hay WW, Paisley WJ. Current Pediatric Diagnosis & Treatment, 10th ed. Appleton & Lange, 1991;121-129.

Zeigler EE, Thuren PJ, Carlson SJ. Aggressive nutrition in a very low birth weight infant. Clinics in Perinatology. 2002;29:225. doi:10.1016/S0095-5108(02)00007-6 PMID:12168239

Puntis JW.L. Nutritional support in nonatology, In: Sobotka L. Basics in clinical nutrition 3 rd ed. Prague: Galen - ESPEN, 2004: 425

Berthold Koletzko, Olivier Goulet, Joanne Hunt, Kathrin Krohn, and Raanan Shamir. for the Parenteral Nutrition Guidelines Working Group: Organisational Aspects of Hospital PN. Journal of Pediatric Gastroenterology and Nutrition. 2005;41(2):S63-S69. doi:10.1097/01.mpg.0000181850.46994.b2

Carter BA, Shulman RJ. Mechanisms of disease: update on the molecular etiology and fundamentals of parenteral nutrition associated cholestasis, Nat Clin Pract Gastroenterol Hepatol. 2007 May; 4(5):277-87. doi:10.1038/ncpgasthep0796

Martin A Crook. Lipid clearance and total parenteral nutrition: the importance of monitoring plasma lipids. Nutrition. 2000;16(9):774-775. doi:10.1016/S0899-9007(00)00381-6 PMID:10978859

De Leeuw R, Kok K, DeVries IJ, Beganovic H. Tolerance of Intrave-nously Administered Lipid in Newborns. Acta Pediatr Scand. 1985;74: 52-56. doi:10.1111/j.1651-2227.1985.tb10920.x

Giovannini I Chiarla C Boldrini G Castagneto M. Impact of fat and Glucose admini-stration on Metabolic and respiratory interactions in sepsis. JPEN. 1989;13:141-146.

Baker JP., Lemoyene M.: Nutritional support in the critically ill patient: If, When, How, and What. Critical care Clinics. 1987;3:97-113.

Gounaris A Analitou F Costalos C Konstantellou E.: Minimal Enteral feed-ing, Nasojejunal Feeding and Gastrin Levels in Premature Infants, Short Communication. Acta Pediatr Scand. 1990;79:226-227. doi:10.1111/j.1651-2227.1990.tb11443.x

Zeigler EE, Thuren PJ, Carlson SJ. Aggressive nutrition in very low birthweight infant. Clinics in Perinatology. 2002;29:225. doi:10.1016/S0095-5108(02)00007-6 PMID:12168239

Giovannini I Chiarla C Boldrini G Castagneto M.: Impact of fat and Glucose admini-stration on Metabolic and respiratory interactions in sepsis. JPEN. 1989;13:141-146.

Ibrahim HM, Jeroudi MA, Baier RJ, Dhanireddy R, Krouskop RW. Aggressive early total parental nutrition in low-birth-weight infants. J Perinatol. 2004;24(8):482-6. doi:10.1038/sj.jp.7211114 PMID:15167885

Macedonian Journal of Medical Sciences

The Journal of ID Design 2012/DOOEL Skopje, Republic of Macedonia on behalf of the Macedonian Donor Registry (MKDR), Skopje, Republic of Macedonia

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