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Dose of intravenous lipids and rate of bacterial clearance in preterm infants with blood stream infections

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Abstract

Background

Intravenous lipid emulsion (IVLE) is an integral part of the total parenteral nutrition (TPN) regimen in neonates. The use of IVLE during sepsis is the subject of controversy because it may interfere with phagocytosis of microbes by macrophages and may lead to significant hypertriglyceridemia.

Objective

This paper aims to study the rate of clearance of bacteria in relation to dose of IVLE administered to preterm infants with blood stream infections (BSIs).

Methods

Preterm infants (mean gestational age ± SD, 32.0 ± 2.5 weeks) with culture-proven BSI and receiving TPN were randomized to two groups. The first group (n = 22) was given the usual dose of IVLE according to a standard protocol (starting from 0.5 g kg−1 day−1 and gradually increased by 1 g kg−1 day−1 to a maximum of 3.5 g kg−1 day−1); in the second group (n = 20), IVLE were restricted at a dose of 1 g kg−1 day−1. Samples for blood cultures were withdrawn every 24 h until a negative culture was obtained. CRP was measured daily until its normalization. Serum triglycerides were monitored daily.

Results

The rate of bacterial clearance was significantly more rapid in the restricted-dose IVLE group compared to the standard-dose group [72 (48–120) versus 144 (72–168) h, p = 0.001]. Daily weight increment was significantly greater in the standard-dose IVLE group compared to the restricted-dose IVLE group [25 (6.9–31.9) versus 0.9 (−3.3–11.7) g, p = 0.0001]. The duration of antibiotic use was significantly reduced in the restricted-dose IVLE group compared with the standard-dose IVLE group (10.0 ± 4.5 vs 14.9 ± 5.1 days; p = 0.003). The durations of TPN, mechanical ventilation, and hospitalization were not significantly different between groups.

Conclusions

Restriction of the dose of IVLE to 1 g kg−1 day−1 in preterm infants with BSI is associated with earlier negative blood cultures and reduced duration of antibiotic therapy but was associated with a lower daily weight increments.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Mansoura, Egypt

    Basma Shouman & Hesham Abdel-Hady

  2. Neonatal Intensive Care Unit, Department of Paediatrics, Mansoura University Children’s Hospital, Mansoura University, Mansoura, Egypt

    Basma Shouman

  3. Department of Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt

    Rawia I. Badr, Enas Hammad & Mona F. Salama

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  1. Basma Shouman
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  2. Hesham Abdel-Hady
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  4. Enas Hammad
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Correspondence to Basma Shouman.

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Shouman, B., Abdel-Hady, H., Badr, R.I. et al. Dose of intravenous lipids and rate of bacterial clearance in preterm infants with blood stream infections. Eur J Pediatr 171, 811–816 (2012). https://doi.org/10.1007/s00431-011-1619-y

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  • DOI: https://doi.org/10.1007/s00431-011-1619-y

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