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Pulmonary intravascular lipid at neonatal post mortem: a ten year prospective study
and emulsifier composition (phosphatidyl ethanolamine./phosphatidyl choline ratio 0.16 or 0.24). Lipid dosage was aimed at 2.5 g/kg.d but was adjusted using nephelometry when plasma lipid concentrations exceeded 150 mg/dl. At 16-11 AM at day 7 during continuous TPN of 150 m!/kg.d plasma samples were taken to determine triglycerides, free glycerol and cholesterol. Results + 1 SD: upidrmplntk PERta Numb9rofikts
BodlwWf (kg) Gesf.ageW) Fatinlska (glkg.4 Ti@yc.(mmoVil Freeglyc.(mmo# cholast.(mmol/n
A lrm)
0.12 0.16 11 1.31 to.56 31.6t2.9 1.93+0.57 2.5321.13 0.17~0.09 3.96?1.48
s (10%) 0.12 a24 16 1.29tO.30 3I.Ok2.3 2.36+0.09 1.17+0.74 0.25?0.14 4.08tO.69
c (20%)
0.06 0.16 I4 1.44t0.40 31.5t2.6 2.06?0.85 1.15+0.73 0.19~0.11 2.1ato.95
Albumin
a iZ’I%l
0.06 0.24 7 1.44to.55 31.or1.9 2.49fO.M) 1.28t0.46 0.14~0.05 2.55k0.45
Statistical analysis was performed using MANOVA leading to the conclusions: (1) 20% lipid solutions cause lower plasma levels of cholesterol (p < 0.005). (2) Significantly improved lipid clearance using a higher emulsifier PE/PC ratio was observed in 10% (p < 0.005) but not in 20% lipid solutions. Use of 20% lipid emulsions deserves preference for TPN in preterm infants.
Dav QWP 1 IL 4501 4 IL 4501 6 IL 4501 9 IL 4501
TBPA
A.P.
Crealfnitm Pfatebb Ttigtycericba
iIO%J? lmpldff wmo IQM h'dl)' (fun)" IWdll I 47Ot335 3.30t0.447.622.1469t120 0.86tO.19276+1OI 82.3i31.7 1 4Olt306 3.2LBO.427.Ot2.0458ti45 0.95?0.29243k91 621t213 0.71?0.213wilO8 63.6224 7 1 45ot357 3.57to.479.2t1.846oM6 1 361t313 34OtO.39 7.7t2.952Oti22 OWO.26 291+124 63.It24 _ 1 46at359 3OQ?II3 55.6Y22.3 _ _ _ 1 405t321 372t149 6X9+20 I 539?368 3.18+0.609.0+2.i642tI21 0.67iO.23X17*104 52.3?11.6 1 47Ot331 3.27r0.398.3f3.3746+153 0.7OtO.12386tI96 634k29.1 : TBPA = ThYIOXKN)Bmd~~PPreA~umme: ':A.P=AlkalmePhosphatase
Mean weight gains and differential albumin levels obtained in both groups, between days 1 and 9, were very comparable. Noteworthy are the slow but constant increases of alkaline phosphatase and platelet levels for both groups. The most striking differences were seen on day 4, the protein component of the nutritional status appearing to have improved better in group I. However the TG levels, during the whole study period, were more stable in group II; we conclude at this stage that the new FE - 4501 looks safe and is worthwhile being studied further for more fundamental advantages.
0.26 Pulmonary intravascular lipid at neonatal post mortem: a ten year prospective study J.W.L. Pun& and D.I. Rushton Department of Paediatrics and Child Health, University of Birmingham, UK The purpose of this study was to investigate the relationship between the finding of intravascular fat at necropsy and the use of lipid emulsion during parenteral nutrition. The use of parenteral lipid emulsions in preterm infants is associated with the presence of stainable lipid in the pulmonary vasculature in some necropsies. However, the frequency and significance of this phenomenon is uncertain. We have made a ten year prospective studyof intravascular fat in all neonatal autopsies (n = 414). Of these, 41 received parenteral nutrition (PN), their median (range) gestational age and weight being 26wk (25-40) and 8609 (450-2820). All received amino acid -dextrose solution whilst 30 also had lntralipid 10%. The median (range) duration of PN was 14 days (l-46). Tissue was processed into wax and sections stained for lipid with Sudan black. 15/30 (50%) patients given lntralipid were found to have intravascular lipiddistending pulmonary capillaries. Extra-pulmonaryintravascularfat was found in only one case. None of the infants who had not received PN, or were given amino acid solution alone, showed evidence of intravascular fat. Comparing those with stainable fat and those without, the respective median (range) days of fat infusion were 16 (l-35) and 4 (l-28; p = 0.003) and median (range) of total fat intake 38 g/kg (11-112) and 5.5 g/kg (l-49; p < 0.0001). Intravascular lipid is a common autopsy finding in infants who have received lntralipid and may be related to the quantity of lipid received. We have never seen it at necropsy in babies not fed with an intravenous fat emulsion. The observation that fat is almost exclusively located in small pulmonary capillaries suggests a filtering out process prior to cessation of circulation and mitigates against post mortem artefact. The clinical significance of this finding remains uncertain.
0.26 Clinical and biological efficacy of a new fat emulsion (FE) given to premature neonates D. Brasawr, A. Johansson, M. Rossaneu and 0. B/urn Brussels University Children’s Hospital (US) and Saint Jan Hospital Bruges, Belgium Conventional FE areused during TPN as concentrated sources of energy but also to cover the nutritional needs of essential fatty acids (FA), mainly linoleic and linolenic acids. Young infants and specially premature neonates may have more extensive and more specific FA requirements, as suggested by the FAcomposition of human milk (HM). A FE, tailored more closely to the FA pattern of HM would probably be more appropriate in this age group, with some possible positive impact of membrane composition, e.g. the brain. Before establishing any kind of improved efficacy, metabolic safety and tolerance need to be ascertained. In a double-blind study, 26 premature neonates were randomly assigned to receive either lntralipid - 20% (Kabi) (Group I, n = 12) or a new FE, 4501 20% (Kabi) (Group II, n = 14). This new FE provides carnitine and gamma-linolenic acid at similar amounts as HM when infused at usual dosage for fat. During the period of the study, TPN regimens were isocaloric, isonitrogenous, fat being increased stepwise at a daily rate of 1 @kg so to reach and maintain an infusion rate of 3g/kg during 18 hours a day for another 6 consecutive days. Most important parameters monitored are shown in the table, triglycerides being measured 6 hours after the end of the fat infusion.
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BodlwWf (kg) Gesf.ageW) Fatinlska (glkg.4 Ti@yc.(mmoVil Freeglyc.(mmo# cholast.(mmol/n
A lrm)
0.12 0.16 11 1.31 to.56 31.6t2.9 1.93+0.57 2.5321.13 0.17~0.09 3.96?1.48
s (10%) 0.12 a24 16 1.29tO.30 3I.Ok2.3 2.36+0.09 1.17+0.74 0.25?0.14 4.08tO.69
c (20%)
0.06 0.16 I4 1.44t0.40 31.5t2.6 2.06?0.85 1.15+0.73 0.19~0.11 2.1ato.95
Albumin
a iZ’I%l
0.06 0.24 7 1.44to.55 31.or1.9 2.49fO.M) 1.28t0.46 0.14~0.05 2.55k0.45
Statistical analysis was performed using MANOVA leading to the conclusions: (1) 20% lipid solutions cause lower plasma levels of cholesterol (p < 0.005). (2) Significantly improved lipid clearance using a higher emulsifier PE/PC ratio was observed in 10% (p < 0.005) but not in 20% lipid solutions. Use of 20% lipid emulsions deserves preference for TPN in preterm infants.
Dav QWP 1 IL 4501 4 IL 4501 6 IL 4501 9 IL 4501
TBPA
A.P.
Crealfnitm Pfatebb Ttigtycericba
iIO%J? lmpldff wmo IQM h'dl)' (fun)" IWdll I 47Ot335 3.30t0.447.622.1469t120 0.86tO.19276+1OI 82.3i31.7 1 4Olt306 3.2LBO.427.Ot2.0458ti45 0.95?0.29243k91 621t213 0.71?0.213wilO8 63.6224 7 1 45ot357 3.57to.479.2t1.846oM6 1 361t313 34OtO.39 7.7t2.952Oti22 OWO.26 291+124 63.It24 _ 1 46at359 3OQ?II3 55.6Y22.3 _ _ _ 1 405t321 372t149 6X9+20 I 539?368 3.18+0.609.0+2.i642tI21 0.67iO.23X17*104 52.3?11.6 1 47Ot331 3.27r0.398.3f3.3746+153 0.7OtO.12386tI96 634k29.1 : TBPA = ThYIOXKN)Bmd~~PPreA~umme: ':A.P=AlkalmePhosphatase
Mean weight gains and differential albumin levels obtained in both groups, between days 1 and 9, were very comparable. Noteworthy are the slow but constant increases of alkaline phosphatase and platelet levels for both groups. The most striking differences were seen on day 4, the protein component of the nutritional status appearing to have improved better in group I. However the TG levels, during the whole study period, were more stable in group II; we conclude at this stage that the new FE - 4501 looks safe and is worthwhile being studied further for more fundamental advantages.
0.26 Pulmonary intravascular lipid at neonatal post mortem: a ten year prospective study J.W.L. Pun& and D.I. Rushton Department of Paediatrics and Child Health, University of Birmingham, UK The purpose of this study was to investigate the relationship between the finding of intravascular fat at necropsy and the use of lipid emulsion during parenteral nutrition. The use of parenteral lipid emulsions in preterm infants is associated with the presence of stainable lipid in the pulmonary vasculature in some necropsies. However, the frequency and significance of this phenomenon is uncertain. We have made a ten year prospective studyof intravascular fat in all neonatal autopsies (n = 414). Of these, 41 received parenteral nutrition (PN), their median (range) gestational age and weight being 26wk (25-40) and 8609 (450-2820). All received amino acid -dextrose solution whilst 30 also had lntralipid 10%. The median (range) duration of PN was 14 days (l-46). Tissue was processed into wax and sections stained for lipid with Sudan black. 15/30 (50%) patients given lntralipid were found to have intravascular lipiddistending pulmonary capillaries. Extra-pulmonaryintravascularfat was found in only one case. None of the infants who had not received PN, or were given amino acid solution alone, showed evidence of intravascular fat. Comparing those with stainable fat and those without, the respective median (range) days of fat infusion were 16 (l-35) and 4 (l-28; p = 0.003) and median (range) of total fat intake 38 g/kg (11-112) and 5.5 g/kg (l-49; p < 0.0001). Intravascular lipid is a common autopsy finding in infants who have received lntralipid and may be related to the quantity of lipid received. We have never seen it at necropsy in babies not fed with an intravenous fat emulsion. The observation that fat is almost exclusively located in small pulmonary capillaries suggests a filtering out process prior to cessation of circulation and mitigates against post mortem artefact. The clinical significance of this finding remains uncertain.
0.26 Clinical and biological efficacy of a new fat emulsion (FE) given to premature neonates D. Brasawr, A. Johansson, M. Rossaneu and 0. B/urn Brussels University Children’s Hospital (US) and Saint Jan Hospital Bruges, Belgium Conventional FE areused during TPN as concentrated sources of energy but also to cover the nutritional needs of essential fatty acids (FA), mainly linoleic and linolenic acids. Young infants and specially premature neonates may have more extensive and more specific FA requirements, as suggested by the FAcomposition of human milk (HM). A FE, tailored more closely to the FA pattern of HM would probably be more appropriate in this age group, with some possible positive impact of membrane composition, e.g. the brain. Before establishing any kind of improved efficacy, metabolic safety and tolerance need to be ascertained. In a double-blind study, 26 premature neonates were randomly assigned to receive either lntralipid - 20% (Kabi) (Group I, n = 12) or a new FE, 4501 20% (Kabi) (Group II, n = 14). This new FE provides carnitine and gamma-linolenic acid at similar amounts as HM when infused at usual dosage for fat. During the period of the study, TPN regimens were isocaloric, isonitrogenous, fat being increased stepwise at a daily rate of 1 @kg so to reach and maintain an infusion rate of 3g/kg during 18 hours a day for another 6 consecutive days. Most important parameters monitored are shown in the table, triglycerides being measured 6 hours after the end of the fat infusion.
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