Hypertriglyceridemia and lipid tolerance in preterm infants with a birth weight of less than 1250 g on routine parenteral nutrition

Giretti, Ilaria; D’Ascenzo, Rita; Correani, Alessio; Antognoli, Luca; Monachesi, Chiara; Biagetti, Chiara; Pompilio, Adriana; Marinelli, Lorenzo; Burattini, Ilaria; Cogo, Paola; Carnielli, Virgilio P.

doi:10.1016/j.clnu.2020.12.039

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Similar to previous studies, our findings suggest that GA, BW and to be SGA at birth were significant risk factors for the development of HiTG [28,30]. Similar to Sinclair et al [30], the rate of mortality is not influenced by HiTG.…”

Section: Discussionsupporting

confidence: 91%

“…Additionally, in this paper, no data were reported regarding the effect of ILEs or HiTG on clinical outcome. More recently, in a retrospective study, Giretti et al [28] identified respiratory distress syndrome as a risk factor for HiTG in preterm newborns with BWs less than 1250 g. Despite the authors demonstrating an association between respiratory distress syndrome and lipid tolerance, the occurrence of respiratory distress syndrome preceded HiTG. In a similar population, the same research group, in a retrospective case-control study [29], did not find any relation between HiTG and BPD.…”

Section: Discussionmentioning

confidence: 97%

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Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

et al. 2021

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(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case–control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4–10 days vs. 4 days, 95% CI 1–7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

et al. 2021

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“…Moreover, RGZ administration in diabetic patients increases the risk of heart failure and cardiovascular mortality [ 41 ]. Alterations of plasma lipid levels are of particular concern in the most premature babies (<28 weeks’ gestation), who are at the highest risk of developing BPD and are prone to hypertriglyceridemia due to their prematurity-associated low lipoprotein lipase activity and reduced endothelial function [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Daily Intraperitoneal Administration of Rosiglitazone Does Not Improve Lung Function or Alveolarization in Preterm Rabbits Exposed to Hyperoxia

Aquila

Regin

Murgia³

et al. 2022

Pharmaceutics

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Thiazolidinediones (TZDs) are potent PPARγ agonists that have been shown to attenuate alveolar simplification after prolonged hyperoxia in term rodent models of bronchopulmonary dysplasia. However, the pulmonary outcomes of postnatal TZDs have not been investigated in preterm animal models. Here, we first investigated the PPARγ selectivity, epithelial permeability, and lung tissue binding of three types of TZDs in vitro (rosiglitazone (RGZ), pioglitazone, and DRF-2546), followed by an in vivo study in preterm rabbits exposed to hyperoxia (95% oxygen) to investigate the pharmacokinetics and the pulmonary outcomes of daily RGZ administration. In addition, blood lipids and a comparative lung proteomics analysis were also performed on Day 7. All TZDs showed high epithelial permeability through Caco-2 monolayers and high plasma and lung tissue binding; however, RGZ showed the highest affinity for PPARγ. The pharmacokinetic profiling of RGZ (1 mg/kg) revealed an equivalent biodistribution after either intratracheal or intraperitoneal administration, with detectable levels in lungs and plasma after 24 h. However, daily RGZ doses of 1 mg/kg did not improve lung function in preterm rabbits exposed to hyperoxia, and daily 10 mg/kg doses were even associated with a significant lung function worsening, which could be partially explained by the upregulation of lung inflammation and lipid metabolism pathways revealed by the proteomic analysis. Notably, daily postnatal RGZ produced an aberrant modulation of serum lipids, particularly in rabbit pups treated with the 10 mg/kg dose. In conclusion, daily postnatal RGZ did not improve lung function and caused dyslipidemia in preterm rabbits exposed to hyperoxia.

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“…In this cohort, only one patient had hypertriglyceridemia that persisted for three consecutive days, despite several patients having provisions above the recommended maximum. A multiple logistic regression model by Giretti et al [ 33 ] might explain this apparent lack of association; although each additional intravenous lipid intake of 1 g/kg/d increased the risk of hypertriglyceridemia by 96%, for each week of GA, and for each g/kg/d of amino acid intake, the risk of hypertriglyceridemia was reduced by 12% and 19%, respectively [ 33 ]. Moreover, the use of fish oil emulsions was associated with a significantly lower risk of hypertriglyceridemia (a reduction of 38%), which the authors traced back to lipogenesis downregulation by fish oil emulsions.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Adherence to ESPGHAN 2018 Guidelines in the Neonatal Intensive Care Unit of the Ghent University Hospital: A Retrospective Study

De Cloet,

Simal,

Benoot

et al. 2023

Nutrients

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Parenteral nutrition (PN) is a standard of care for preterm infants in the first postnatal days. The European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) has updated their guideline recommendations on PN in 2018. However, data on actual 2018 guideline adherence in clinical practice are sparse. In this retrospective study, conducted at the neonatal intensive care unit (NICU) of Ghent University Hospital, we analyzed the ESPGHAN 2018 PN guideline adherence and growth for 86 neonates admitted to the NICU. Analyses were stratified by birth weight (<1000 g, 1000 to <1500 g, ≥1500 g). We documented the provisions for enteral nutrition (EN) and PN, and we tested the combined EN and PN provisions for ESPGHAN 2018 adherence. The nutrition protocols showed a high adherence to PN guidelines in terms of carbohydrate provisions, yet lipid provisions for EN and PN often exceeded the recommended maximum of 4 g/kg/d; although, PN lipid intakes maxed out at 3.6 g/kg/d. Protein provisions tended to fall below the recommended minimum of 2.5 g/kg/d for preterm infants and 1.5 g/kg/d for term neonates. The energy provisions also tended to fall below the minimum recommendations, especially for neonates with a birth weight (BW) < 1000 g. Over a mean PN duration of 17.1 ± 11.4 d, the median weekly Fenton Z-scores changes for length, weight, and head circumference were positive for all BW groups. Future studies have to assess how protocols adapt to current guidelines, and how this affects short- and long-term growth across different BW groups. In conclusion, the reported findings provide real-world evidence regarding the effect of ESPGHAN 2018 PN guideline adherence, and they demonstrate how standardized neonatal PN solutions can safeguard stable growth during NICU stays.

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Hypertriglyceridemia and lipid tolerance in preterm infants with a birth weight of less than 1250 g on routine parenteral nutrition

Cited by 11 publications

References 18 publications

Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

Daily Intraperitoneal Administration of Rosiglitazone Does Not Improve Lung Function or Alveolarization in Preterm Rabbits Exposed to Hyperoxia

Assessment of the Adherence to ESPGHAN 2018 Guidelines in the Neonatal Intensive Care Unit of the Ghent University Hospital: A Retrospective Study

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