PLASMA-CHOLESTEROL AND TRIGLYCERIDE PROFILES AND PREVALENCE OF ESSENTIAL FATTY-ACID DEFICIENCY IN VERY-LOW-BIRTH-WEIGHT INFANTS INFUSED WITH A 10-PERCENT OR 20-PERCENT LIPID EMULSION

Objective, To compare the cholesterol and triglyceride levels obtained in very-low-birth-weight (VLBW) infants infused with 10% or 20% Lipov enous (Intramed) or 10% or 20% Intralipid (Pharmacia) and to determine the effect on the triene/tetraene ratio (TTR). Design. A double-blind randomly controlled study, Setting, The study was undertaken in the n eonatal wards of Tygerberg Hospital.Study subjects. Forty VLBW infants were randomly assigned to four groups of 10 each, who were to receive either 10% or 20% Lipovenous or 10% or 20% Intralipid from day 3 to 9 of life, Outcome measures, Plasma cholesterol and triglyceride concen trations were determined on days 3, 6 and 9 of life, Essential fatty a cid deficiency was confirmed when the TTR was > 0.2. Results. Although no significant differences in the mean cholesterol levels on day 6 an d 9 were noted between infants receiving either Lipovenous or Intralip id, the cholesterol levels of the infants treated with the 10% fat emu lsions were significantly higher than those receiving the 20% emulsion s. The plasma triglyceride levels increased over time, and this was no t influenced by either the type or fat concentration of the lipid emul sion. The mean plasma triglyceride levels, however,. remained well bel ow the accepted normal level of 150 mg/dl during the study period. Nin e infants (23%) had TTRs > 0.2 on day 3 but these normalised over the 6 days of parenteral fat administration. Conclusions. Fat should be ad ded to the diets of VLBW infants before day 3 of life. Given the signi ficantly higher mean plasma cholesterol revers in the infants treated with the 10% lipid emulsions, we suggest that a 20% emulsion be used i n parenteral nutrition in,VLBW infants.