689 - Monitoring and Management of Hypertriglyceridemia in Extremely Low Birth Weight Neonates Receiving Lipid Infusions: A National Survey

Extremely preterm neonates rely on parenteral lipid infusions to provide a source of non-carbohydrate energy and essential fatty acids. However, concern regarding the development of hypertriglyceridemia and its sequelae exists. The definition of hypertriglyceridemia in preterm neonates has not been well defined. Initiation and advancement of lipid infusions are based on experience rather than scientific evidence. 

Objective:

This study aims to assess the current practice variation of monitoring and managing hypertriglyceridemia in extremely low birth weight neonates. High variation will underline the need for additional studies that provide a more scientific basis for more appropriate and consistent management practices.

Design/Methods:

An 8-question survey created via the web survey site Qualtrics was distributed to neonatologists, neonatal nurse practitioners and fellows within the Section of Neonatal-Perinatal Medicine email directory list in the United States and Canada. Survey results were obtained between August to September 2022

Results:

There were 249 respondents from approximately 4,000 members within the Section of Neonatal-Perinatal Medicine. Responses were documented as a frequency (percentage) with a margin of error of plus or minus 6.2 %. Majority of respondents were neonatologists, individuals practicing for > 10 years and reported a unit-based policy for lipid infusion initiation and advancement. The definitions of hypertriglyceridemia varied among respondents, with the majority (42.7 %) reporting a threshold of > 200 mg/dl. 18.95 % of respondents reported not routinely monitoring serum triglyceride concentrations with variable triglyceride monitoring intervals noted otherwise. Regarding elevated triglyceride levels, 19.0 % said decreasing lipid infusion rates and checking triglyceride levels until normalization, 14.6 % reported discontinuation of lipid infusion and checking triglyceride levels until normalization, 61.9 % reported using a combination of both practices above, and 4.5 % reported individualized approaches for management of lipid infusions with elevated triglyceride levels.

Conclusion(s):

This survey demonstrates high variation in defining, monitoring, and managing hypertriglyceridemia in extremely low birth weight neonates and emphasizes the need for studies to guide this practice better.