Early versus late introduction of lipids in parenterally fed preterm infants, and nosocomial infection

Abstract EN

Background: Concerns have been expressed about the potential adverse effects of 'early' lipid infusions in preterm infants including increased rates of sepsis.

Aims: to assess the effect of early introduction of parenteral lipids (started within 48 hours) compared to delayed lipids introduction (started after 5 days) on the rate of late sepsis in VLBW infants.

Methods: The study included 371 VLBW infants in the setting of a regional neonatal intensive care unit.

Babies admitted from January 1997 to December 1998 (group II) received a conservative nutritional regimen while group I (admitted from January 1999 to December 2000), received a package of more aggressive parenteral nutrition with early introduction of lipid emulsion.

Statistical analysis was done using Student's ttest.

Results: Lipid was started earlier in group I than group II (1.8 ±0.9 days v 5.1 ±0.7 days respectively, p< 0.005).

The maximum lipid intake at the age of 7 days in group I was significantly higher than that in group II ( 2.8 ±0.7 g/kg/d v 1.1± 0.6 g/kg/d; p < 0.005).

There was no significant difference in serum triglyceride level at that age between the 2 groups (1.4 ± 0.6 mmol/l v 1.24 ± 0.6 mmol/l; p > 0.05).

Forty eight infants (24.6%) in group I developed late bacterial sepsis (including coagulase negative staphylococcal sepsis) compared to 46 infants (26.1%) in group II, p > 0.05, meanwhile, 25 infants (14.2%) in group II developedfungal sepsis compared to only 11 infants (5.6%) in group I; p = 0.005.

Early growth was better in group I than group II with significantly lower mean maximal percentage birth weight loss (7.6± 0.6 v 11.5+0.7, p < 0.05),and mean duration of time to regain birth weight (9.2 ±1.3 days v 14.5 ± 1.8 days, p < 0.05).

Conclusion: Early introduction of lipids to parenterally-fed preterm infants was well tolerated and did not cause increased risk of sepsis among these infants.

At the same time, it positively affected the early growth of these infants.