Safety and Efficacy of Early High Parenteral Lipid Supplementation in Preterm Infants: A Systematic Review and Meta-Analysis

Abstract

The objective of this systematic review and meta-analysis was to summarize the effects of early initiation and achievement of a high dose of parenteral lipids (≥1.5 g/kg/day reached within the first 24 h of birth) on growth and adverse outcomes in preterm infants. PubMed, EMBASE, and Cochrane databases were utilized to search for publications for this meta-analysis. Randomized controlled trials were eligible if data on growth or clinical outcome was available. The search returned nine studies. The mean proportion of postnatal weight loss (%) was lower (mean difference [MD]: −2.73; 95% confidence interval [CI]: −3.69, −1.78), and the mean head circumference near the term equivalent age (cm) was higher in the early high lipid treatment group (MD: 0.67; 95% CI: 0.25, 1.09). There was a favorable association of early high lipid administration with the incidence of extrauterine growth restriction (relative risk [RR]: 0.27; 95% CI: 0.15, 0.48). Generally, there were no differences in morbidities or adverse outcomes with early high lipid administration. Early initiation of parenteral lipids and high dose achieved within the first 24 h of life appear to be safe and endurable and offer benefits in terms of growth.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

“…Early initiation of higher levels of parenteral amino acids results in less postnatal growth failure and an increase in positive protein balance [181]. At least 1.5 g/kg intravenous protein and 1–2 g/kg lipids should be started from day 1 and increased to a maximum of 3.5 g/kg amino acid [182, 183]. For stable infants, a small amount (0.5–1 mL/kg/h) of breast milk can be started early to initiate enteral feeding [184].…”

Hindmilk as a Rescue Therapy in Very Preterm Infants with Suboptimal Growth Velocity

“…Previous studies on hindmilk did not reveal a significant change in head growth after hindmilk; however, these studies monitored head circumference for shorter durations [ 7 , 25 , 26 ]. It is noteworthy that provision of high early parenteral fat intake of 2–3 g/kg/day starting soon after birth resulted in a significant increase in head circumference at 36 weeks PMA [ 32 , 33 ]. A meta-analysis of 4 RCTs indicated a 0.67 (95%CI 0.25, 1.09) cm increase in head size at term equivalent age after high parenteral fat intake [ 33 ].…”

“…It is noteworthy that provision of high early parenteral fat intake of 2–3 g/kg/day starting soon after birth resulted in a significant increase in head circumference at 36 weeks PMA [ 32 , 33 ]. A meta-analysis of 4 RCTs indicated a 0.67 (95%CI 0.25, 1.09) cm increase in head size at term equivalent age after high parenteral fat intake [ 33 ]. Higher energy and fat intake in the first two weeks after birth was associated with a lower incidence of brain lesions and dysmaturation at term equivalent age in very preterm infants [ 34 ].…”

“…Higher energy and fat intake in the first two weeks after birth was associated with a lower incidence of brain lesions and dysmaturation at term equivalent age in very preterm infants [ 34 ]. Although these studies used parenteral fat, they alluded to the key role of adequate fat intake for brain growth and development [ 33 , 34 ]. Nonetheless, the improvement of head z scores in our study was not expected and may have happened by chance due to the small sample size.…”