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Increased risk for early hypertriglyceridemia in small for gestational age preterm infants

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Abstract

Small for gestational age preterm are at increased risk for future metabolic syndrome. Early indication for the disrupted metabolism may be found in the perinatal period. We aimed to evaluate whether small for gestational age preterm infants are at increased risk for hypertriglyceridemia when treated with lipid emulsions, and to investigate the association between triglyceride levels and morbidity. Small for gestational age infants ≤ 34 weeks’ gestation age born during 2013–2016 were matched and compared with appropriate for gestational age counterparts. Triglyceride concentration > 250 mg/dL during treatment with parenteral nutrition was considered high. The study included 71 pairs of preterm infants. Hypertriglyceridemia was documented among 22.5% of the small for gestational age infants vs. 5.6% of the appropriate for gestational age infants (p = 0.007). Mean triglyceride levels were 194.4 ± 192.3 mg/dL and 99.9 ± 82.8 mg/dL, respectively (p < 0.001). Small for gestational age was predictive of hypertriglyceridemia (OR = 6.41; 95% CI 1.8–22.9). No significant association was found between triglyceride levels and morbidities in multivariate analysis.

Conclusion: Small for gestational age preterm infants receiving lipid emulsions might be at a higher risk for hypertriglyceridemia. Routine monitoring of triglyceride levels will enable identification of the necessity for a slower increase in lipid emulsion therapy.

What is Known:

• Moderate and very preterm infants are routinely treated with lipid emulsions.

• Small for gestational age (SGA) infants may have different metabolism, as they demonstrate higher risk for metabolic syndrome.

What is New:

• • SGA infants had a higher mean triglyceride level and more commonly had early hypertriglyceridemia (triglycerides > 250 mg/dL) compared with appropriate for gestational age infants treated with the same intravenous lipid dose. Small for gestational age was predictive of hypertriglyceridemia.

• No significant association was found between triglyceride levels and morbidities in multivariate analysis.

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Abbreviations

AGA:

Appropriate-for-gestational-age

BPD:

Bronchopulmonary dysplasia

BW:

Birth weight

CO:

ClinOleic

EUGR:

Extrauterine growth retardation

GA:

Gestational age

IUGR:

Intrauterine growth restriction

IVH:

Intraventricular hemorrhage

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

PDA:

Patent ductus arteriosus

PVL:

Periventricular leukomalacia

ROP:

Retinopathy of prematurity

SGA:

Small for gestational age

TG:

Triglycerides

TPN:

Total parenteral nutrition

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Author information

Author notes

  1. Shira Rabinowicz and Orly Levkovitz contributed equally as first authors.

Authors and Affiliations

  1. Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel

    Shira Rabinowicz

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shira Rabinowicz, Orly Levkovitz, Leah Leibovitch, Irit Schushan-Eisen, Iris Morag, Chava Rosen, Ayala Maayan-Metzger & Tzipora Strauss

  3. Department of Neonatology, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, 5262000, Tel Hashomer, Israel

    Orly Levkovitz, Leah Leibovitch, Irit Schushan-Eisen, Iris Morag, Chava Rosen, Ayala Maayan-Metzger & Tzipora Strauss

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Contributions

S.R—study design, acquisition of data, analysis and interpretation of data, and drafting the manuscript.

O.L—study design, acquisition of data, analysis and interpretation of data, and drafting the manuscript.

L.L—clinical input and revision the manuscript.

I.SE—data analysis and revision the manuscript.

I.M—clinical input and revision of manuscript.

C.R—clinical input and revision of manuscript.

A.MM—analysis and interpretation of data, and revision of manuscript.

T.S—study conception and design, analysis and interpretation of data, and revision of manuscript.

Corresponding author

Correspondence to Tzipora Strauss.

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Editorial Responsibility: Daniele De Luca

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Rabinowicz, S., Levkovitz, O., Leibovitch, L. et al. Increased risk for early hypertriglyceridemia in small for gestational age preterm infants. Eur J Pediatr 179, 1873–1879 (2020). https://doi.org/10.1007/s00431-020-03764-8

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