ORIGINAL ARTICLE   

Minerva Pediatrics 2023 Dec 21

DOI: 10.23736/S2724-5276.23.07405-0

Copyright © 2023 EDIZIONI MINERVA MEDICA

lingua: Inglese

Unveiling triglyceride levels in preterm neonates: a study to guide targeted monitoring

Palanikumar BALASUNDARAM ¹ ✉, Michelle H. LUCENA ¹, Toshiba MORGAN-JOSEPH ¹, Mimi KIM ², Tomas HAVRANEK ¹, Katie R. FORMAN ¹

¹ Division of Neonatology, Department of Pediatrics, The Children‘s Hospital at Montefiore, New York, NY, USA; ² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA

BACKGROUND: Mixed lipid emulsion (MLE), most commonly soybean, medium chain triglycerides, olive, and fish oils (SMOF), has replaced soybean-based lipid emulsions in many neonatal intensive care units. Only a few studies report the triglyceride (TG) trajectory in neonates receiving MLE. We designed a study to compare TG levels in neonates receiving MLE stratified by gestational age (GA), birth weight (BW), and growth restriction status.
METHODS: We included neonates born at <32 weeks GA or with BW <1500 gm. SMOF is started on admission, and plasma TG levels are measured 24 hours after 2 gm/kg/day and 24 hours after 3 gm/kg/day. TG levels were compared across groups defined by GA (<28 weeks vs. ³28 weeks), BW (<1000 gm vs. ³1000 gm), and small for GA (SGA) vs. appropriate plus large for GA groups using the Wilcoxon rank sum test.
RESULTS: From 2018 to 2021, 427 infants met the inclusion criteria. TG levels were significantly higher in neonates with GA <28 weeks, BW <1000 grams, and SGA with a notable broad distribution of TG levels. Logistic regression analysis confirmed SGA and BW as significant independent predictors of hypertriglyceridemia after SMOF at 2 gm/kg/day and 3 gm/kg/day, respectively.
CONCLUSIONS: The study emphasizes the importance of TG monitoring for neonates with GA <28 weeks, BW <1000 grams, and SGA. Conversely, it is advisable to individualize TG monitoring for infants with GA>28 weeks, BW>1000 grams, and non-SGA status. Prospective studies with larger sample sizes are warranted to validate our findings.

KEY WORDS: Triglycerides; Fat emulsions, intravenous; Infant, premature; Infant, newborn