LIPID INTOLERANCE IN NEWBORNS IS ASSOCIATED WITH HEPATIC-DYSFUNCTION BUT NOT INFECTION

Objective: To examine the hypothesis that fat intolerance in newborns who receive intravenous lipid is related to both infection and liver dysfunction. Design: Prospective survey. Setting: Tertiary intensive care nursery. Patients: All newborns who were admitted to the neonatal intensive care unit during a 20-month period and received parenteral lipid for 2 or more weeks were eligible for the study. Of 279 newborns who received parenteral nutrition, 162 met eligibility criteria and form the basis of this report. Interventions: None. Main Outcome Measure: Fat intolerance as defined by a serum triglyceride level of 1.69 mmol/L or greater (greater than or equal to 150 mg/dL). Results: Triglyceride levels were similar in infected and noninfected patients. Newborns with hypertriglyceridemia were more likely to have liver dysfunction (P<.001) or growth retardation (P<.01), but not infections. Hypertriglyceridemia was approximately twice as likely (P<.05) in newborns with either growth retardation or liver dysfunction. Conclusions: Liver dysfunction and fetal growth retardation were associated with lipid intolerance in newborns who received intravenous fat. Infection does not appear to be independently associated with hypertriglyceridemia. In the absence of liver dysfunction or growth retardation, there is no a priori reason to limit intravenous lipid use in the presence of infection. Close monitoring of triglyceride levels with adjustments in lipid dose is warranted, especially in small, sick newborns who are at highest risk for hypertriglyceridemia.