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. 2023 Jan;47(1):51-58.
doi: 10.1002/jpen.2422. Epub 2022 Jul 16.

Patterns of lipid-injectable emulsion use in neonatal intensive care units across the United States: A multi-institution survey

Katie A Huff  1 , Sujir Pritha Nayak  2 , Irfan Ahmad  3 , Robert DiGeronimo  4 , Amy Hair  5 , Jae H Kim  6 , Troy Markel  7 , Anthony Piazza  8 , Kristina Reber  5 , Jessica Roberts  8 , Jotishna Sharma  9 , Kevin Sullivan  10 , Kaashif A Ahmad  11 , Toby Yanowitz  12 , Muralidhar H Premkumar  5
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Patterns of lipid-injectable emulsion use in neonatal intensive care units across the United States: A multi-institution survey

Katie A Huff et al. JPEN J Parenter Enteral Nutr. 2023 Jan.

Abstract

Background: Lipid-injectable emulsions (ILEs) are a necessity for neonates dependent on parenteral nutrition (PN). In this manuscript, we describe the patterns of ILE use in neonatal intensive care units (NICUs) in the United States (US).

Methods: An electronic survey was sent to 488 NICUs across the US between December 2020 and March 2021. Survey fields included availability and utilization of various ILE in neonates.

Results: The response rate was 22% (107 out of 488). Soybean oil ILE (SO-ILE) and soybean oil, medium-chain triglycerides, olive oil, fish oil ILE (SO, MCT, OO, FO-ILE) had similar availability (87% vs 86%, respectively), and SO, MCT, OO, FO-ILE was more commonly used (SO-ILE, 71% vs SO, MCT, OO, FO-ILE, 86%). Fish oil-ILE (FO-ILE) was used by 55% of centers. SO-ILE was most frequently used with PN and needs <4 weeks without cholestasis (79%). The most common reason for SO, MCT, OO, FO-ILE use was cholestasis (71%). ILE minimization was used by 28% of SO-ILE and 22% of SO, MCT, OO, FO-ILE users; 95% of these centers restrict SO, MCT, OO, FO-ILE to doses ≤2 g/kg/day. Twenty-two percent of centers started FO-ILE at direct bilirubin of >5 mg/dl.

Conclusion: The results of this survey reveal significant variability in ILE usage across the US. Lipid minimization with SO, MCT, OO, FO-ILE and initiation of FO-ILE for cholestasis at higher bilirubin thresholds are prevalent. Such reports are crucial for a better understanding of ILE use in the NICU and in future ILE development.

Keywords: lipids; neonates; parenteral nutrition.

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