Plasma cholesterol and triglycéride profiles and prevalence of essential fatty acid deficiency in very-low-birth-weight infants infused with a 10% or 20% lipid emulsion
Objective. To compare the cholesterol and triglycéride levels obtained in very-low-birth-weight (VLBW) infants infused with 10% or 20% Lipovenous (Intramed) or 10% or 20% Intralipid (Pharmacia) and to determine the effect on the triene/tetraene ratio (TTR). Design. A double-blind randomly controlled study. Setting. The study was undertaken in the neonatal wards of Tygerberg Hospital. Study subjects. Forty VLBW infants were randomly assigned to four groups of 10 each, who were to receive either 10% or 20% Lipovenous or 10% or 20% Intralipid from day 3 to 9 of life. Outcome measures. Plasma cholesterol and triglycéride concentrations were determined on days 3, 6 and 9 of life. Essential fatty acid deficiency was confirmed when the TTR was > 0.2. Results. Although no significant differences in the mean cholesterol levels on day 6 and 9 were noted between infants receiving either Lipovenous or Intralipid, the cholesterol levels of the infants treated with the 10% fat emulsions were significantly higher than those receiving the 20% emulsions. The plasma triglycéride levels increased over time, and this was not influenced by either the type or fat concentration of the lipid emulsion. The mean plasma triglycéride levels, however, remained well below the accepted normal level of 150 mg/dl during the study period. Nine infants (23%) had TTRs > 0.2 on day 3 but these normalised over the 6 days of parenteral fat administration. Conclusions. Fat should be added to the diets of VLBW infants before day 3 of life. Given the significantly higher mean plasma cholesterol levels in the infants treated with the 10% lipid emulsions, we suggest that a 20% emulsion be used in parenteral nutrition in VLBW infants.