687 - Triglyceride Levels in Preterm Neonates Receiving Mixed Lipid Emulsions

The use of Mixed Lipid Emulsion (MLE), most commonly soybean, MCT, olive, and fish oils (SMOF), is replacing traditional soybean-based lipid emulsions in many neonatal intensive care units (NICUs) to protect neonates from developing parenteral nutrition-associated cholestasis. Although studies have demonstrated that MLE does not contribute to hypertriglyceridemia, few studies report the typical triglyceride (TG) trajectory in premature neonates receiving MLE. Similarly, it is unknown if a subset of these neonates is at increased risk of hypertriglyceridemia.

Objective:

To investigate the association of TG levels in neonates receiving MLE and gestational age (GA), birth weight (BW), and growth restriction status. We hypothesize that smaller, younger, and small for gestational age (SGA) neonates would have higher TG levels than their comparison groups.

Design/Methods:

This retrospective study includes neonates admitted to the Children’s Hospital at Montefiore born at < 32 weeks GA or with BW < 1500 gm given SMOF as MLE. Per practice norms, MLE is started on admission, and plasma TG levels are measured 24 hours after MLE infusion at 2 gm/kg/day and 24 hours after 3 gm/kg/day. Neonates without TG levels were excluded. The Wilcoxon rank-sum test was used to compare TG levels across groups defined by GA (< 28 weeks vs. ³28 weeks), BW (< 1000 gm vs. ³1000 gm), and SGA (yes vs. no). Neonates were considered SGA if BW < 10% and LGA if BW >90% based on Fenton growth charts.

Results:

From 2018 - 2021, 427 infants met the inclusion criteria. Baseline characteristics are shown in table 1. When stratified by GA, those < 28 weeks had higher median TG levels after MLE infusion of 2 gm/kg/day (94.5 vs. 71 mg/dL; p = 0.004) and after 3 gm/kg/day (103 vs. 77 mg/dL; p < 0.0001). Similarly, neonates BW < 1000 gm had higher median TG levels after 2 gm/kg/day (93 vs. 69 mg/dL; p = 0.0006) and after 3 gm/kg/day (106 vs.74 mg/dL; p< 0.0001) (Figure 1). SGA infants had a higher median TG level after receiving MLE at 2 gm/kg/day (119 vs. 75 mg/dL; p < 0.0001) and after 3 gm/kg/day (108 vs. 77 mg/dL; p< 0.0001) (Figure 2).

Conclusion(s):

TG levels are significantly higher for neonates < 28 weeks, BW < 1000 gm, and SGA receiving MLE. Median (and mean) values are in the normal range. However, the broad distribution of values is noteworthy and may suggest some of these neonates require more frequent monitoring when receiving MLE. Further investigations should delineate the subset of neonates with very high levels to characterize this relationship more thoroughly.