Safety and Efficacy of Early High Parenteral Lipid Supplementation in Preterm Infants: A Systematic Review and Meta-Analysis

Abstract

The objective of this systematic review and meta-analysis was to summarize the effects of early initiation and achievement of a high dose of parenteral lipids (≥1.5 g/kg/day reached within the first 24 h of birth) on growth and adverse outcomes in preterm infants. PubMed, EMBASE, and Cochrane databases were utilized to search for publications for this meta-analysis. Randomized controlled trials were eligible if data on growth or clinical outcome was available. The search returned nine studies. The mean proportion of postnatal weight loss (%) was lower (mean difference [MD]: -2.73; 95% confidence interval [CI]: -3.69, -1.78), and the mean head circumference near the term equivalent age (cm) was higher in the early high lipid treatment group (MD: 0.67; 95% CI: 0.25, 1.09). There was a favorable association of early high lipid administration with the incidence of extrauterine growth restriction (relative risk [RR]: 0.27; 95% CI: 0.15, 0.48). Generally, there were no differences in morbidities or adverse outcomes with early high lipid administration. Early initiation of parenteral lipids and high dose achieved within the first 24 h of life appear to be safe and endurable and offer benefits in terms of growth.

Keywords: adverse effect; growth; lipids; preterm infants.

Figure 1

Overview of the selection process throughout the study.

Figure 2

Risk of bias assessment of the randomized controlled trials included meta-analysis.

Figure 3

(a–f): Meta-analysis of the effects of early high IVLE that reached a lipid dose equal to or greater than 1.5 g/kg/day within the first 24 h on the growth of preterm infants compared with controls (random effects). IV, inverse variance; M-H, Mantel–Haenszel; CI, confidence interval; TEA, term equivalent age; EUGR, extrauterine growth restriction.

Figure 4

(a–i): Meta-analysis of the effects of early high IVLE that reached a lipid dose equal to or greater than 1.5 g/kg/day within the first 24 h on clinical outcomes and morbidities in preterm infants compared with controls (random effects). IV, inverse variance; M-H, Mantel–Haenszel; CI, confidence interval; NICU, neonatal intensive care unit; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity.

Figure 4

(a–i): Meta-analysis of the effects of early high IVLE that reached a lipid dose equal to or greater than 1.5 g/kg/day within the first 24 h on clinical outcomes and morbidities in preterm infants compared with controls (random effects). IV, inverse variance; M-H, Mantel–Haenszel; CI, confidence interval; NICU, neonatal intensive care unit; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity.