Randomized Clinical Trial of Early Aggressive Versus Late and Slow Intravenous Lipid Infusion in Preterm Infants and Bilirubin and Lipid Profiles

Objective: This study aimed to compare lipid profiles and total serum bilirubin of early aggressive versus late and slow intravenous fat emulsion infusion, in very-low-birth-weight premature infants over the first seven days of life. Methods: A randomized, nonblinded and controlled trial that took place from January 2011 through June 2011 at the level III neonatal intensive care unit at Prince Hashem Bin Al-Hussein Hospital. Thirty low birth weight premature infants were randomized to three groups: Group A received Glucose 10% for the first 48 hours then 1g/kg/day Amino Acids and Intralipids and advanced by 1 g/kg/day on daily base to a total of 3.5g/kg/day and 3g/kg/day respectively. Group B received Glucose 10% and 1g/kg/day Amino Acids and Intralipids on day one and advanced by 1 g/kg/day, daily to a total of 3.5g/kg/day and 3g/kg/day respectively and Group C received Glucose 10%, 3.5g/kg/day Amino Acids and Intralipids 2g/kg/day started at birth then the intravenous intralipids advanced to 3g/kg/day on the next day. Serum levels of bilirubin, cholesterol and triglycerides were taken daily for all patients over the first seven days of life. Infants enrolled in this study had gestational ages between 28 and 32 weeks and had birth weights between 880 and 1500g. Infants who had serious congenital anomalies and/or developed early sepsis were excluded from participation. Data were analyzed using the Statistical Package for Social Sciences version 15. Repeated measures analysis of variance was used to test for the differences in the change of bilirubin, total cholesterol, and triglycerides over time and between groups A, B and C. Results: The energy intake per day in group C remained statistically greater than that in group B and much greater than in group A for the first five days of the study period. There was no statistically significant difference in the mean fluid intake between the three groups. The mean fluid intake in all groups at seven days postnatal age was 162±8.5 ml/kg/day. During the study period, there were no clinically statistically significant differences in the mean serum cholesterol (102, 100, and 110 mg/dl), and mean serum triglyceride (92, 95.2, and 95.3 mg/dl), between group A, B, and C. The mean serum indirect bilirubin was greater in group C compared to group A and B (7.6, 5.74, and 7.14 mg/dl) but no clinical statistically difference between the three groups could be found. Levels of bilirubin, total cholesterol, and triglycerides increased linearly and significantly over the first seven days in all groups but did not rise to a serious level that needed intervention. The changes in these parameters were not different between the three groups. JRMS December 2013; 20(4): 50-56 / DOI: 10.12816/0001550 From the Departments of Pediatrics: *Prince Hashem Bin Al-Hassan Hospital, (PHHH) Zarqa-Jordan **Queen Alia Heart Institute, King Hussein Medical Center, (KHMC), Amman-Jordan Correspondence should be addressed to Dr. G Salama, (PHHH), E-mail: [email protected] Manuscript received June 11, 2011. Accepted November 17, 2011 JOURNAL OF THE ROYAL MEDICAL SERVICES Vol. 20 No. 4 December 2013 50 Conclusion: We conclude that early aggressive use of Intralipids (2g/kg/day immediately after birth) not only can be tolerated in low birth weight premature infants but also can significantly increase caloric intake that associated with no adverse effect on total serum bilirubin, total serum triglyceride and cholesterol concentrations. However, according to our study results there is no need for daily monitoring of total serum bilirubin and lipids profiles.