Parenteral Soybean Oil Lipid Emulsion in Very Low Birth Weight (VLBW) in Intensive Care

2015 ◽  
pp. 1807-1815
Author(s):  
Hiromichi Shoji ◽  
Toshiaki Shimizu
Author(s):  
José Uberos ◽  
Sara Jiménez-Montilla ◽  
Manuel Molina-Oya ◽  
Pelayo Nieto-Gómez ◽  
Isabel Cubero Millan

AbstractIntralipid (Fresenius Kabi) was the most commonly used lipid emulsion in parenteral nutrition (PN), with a 100% soybean oil composition, a low vitamin E content, and a ω-6: ω-3 ratio of 7:1. A recent alternative formulation is SMOFlipid (Fresenius Kabi), with a ω-6: ω-3 ratio of 5:2 and higher vitamin E content. A retrospective observational study was conducted to determine neonatal morbidity in very low birth weight (VLBW) premature infants during two periods: P1, when PN was based exclusively on Intralipid, and P2, when only SMOFlipid was supplied. In total, 170 VLBW neonates were analyzed, of whom 103 received PN for more than 6 days, 56 during P1, and 47 during P2. In both periods, the antenatal and neonatal characteristics of the cohort were comparable. In this analysis, the prevalence of associated comorbidities was determined. During P2, there were fewer cases of moderate to severe bronchopulmonary dysplasia (BPD) and of cholestasis, but more cases of late sepsis, mainly Staphylococcus epidermidis. No changes in the prevalence of other neonatal comorbidities were observed. We believe that the SMOFlipid used in PN could discreetly improve the prevalence of cholestasis or BPD.


2016 ◽  
Vol 61 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Jadwiga Wójkowska-Mach ◽  
T. Allen Merritt ◽  
Maria Borszewska-Kornacka ◽  
Joanna Domańska ◽  
Ewa Gulczyńska ◽  
...  

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 357-357
Author(s):  
WILLIAM TARNOW-MORDI ◽  
ANDREW WILKINSON

To the Editor.— In their valuable report1 Dr Hack and colleagues confirm large variations between centers in the perinatal histories, treatment, and outcomes of very low birth weight infants. Unfortunately, in contrast to earlier reports,2,3 they neglect to mention the need for measures of initial disease severity. This is an important omission. In a survey of nine pediatric intensive care centers Pollack et al4 showed that hospital mortality varied from 3.6% to 17%. This large variation was explained completely by differences between hospital populations in initial severity of disease, calculated from routine indices of physiologic stability on the day of admission.


1983 ◽  
Vol 308 (22) ◽  
pp. 1330-1337 ◽  
Author(s):  
Michael H. Boyle ◽  
George W. Torrance ◽  
John C. Sinclair ◽  
Sargent P. Horwood

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 225-230 ◽  
Author(s):  
James E. Gray ◽  
Douglas K. Richardson ◽  
Marie C. McCormick ◽  
Donald A. Goldmann

Objective. To examine the impact of admission-day illness severity on nosocomial bacteremia risk after consideration of traditional risk determinants such as birth weight and length of stay. Methods. The hospital courses for 302 consecutive very low birth weight (less than 1500 g) infants admitted to two neonatal intensive care units were examined for the occurrence of nosocomial coagulase-negative staphylococcal bacteremia. Using both cumulative incidence and incidence density as measures of bacteremia risk, we explored the relation between illness severity (as measured by the Score for Neonatal Acute Physiology [SNAP]) and bacteremia both before and after birth weight adjustment. In addition, the effect of bacteremia on hospital resource use was estimated. Results. Coagulase-negative staphylococcus was the most common pathogen noted in blood cultures drawn at 48 hours after admission or later. It was isolated on at least one occasion in 53 patients (cumulative incidence of 17.5 first episodes per 100 patients). These episodes occurred during 7652 days at risk, giving an incidence density of 6.9 initial bacteremias per 1000 patient-days at risk. As expected, when compared with the nonbacteremic group, bacteremic patients were of lower birth weight (888 ± 231 vs 1127 ± 258 g; P < .01) and gestational age (26.4 ± 2.1 vs 28.9 ± 2.8 weeks; P < .01). In addition, these patients were more severely ill on admission (SNAP 17.3 ± 6.5 vs 12.2 ± 5.8; P < .01). Even after birth weight stratification, the risk of bacteremia by both measures increased with higher SNAP scores. For example, among infants with birth weights greater than 1 kg, 25% of the most severely ill patients (SNAP 20 and higher) experienced at least one bacteremic episode, whereas the rates seen in infants with intermediate (SNAP 10 to 19) and low illness severity (SNAP 0 to 9) were 8.6% and 3.0%, respectively (χ2 for trend = 7.25; P < .01). Multivariate linear regression showed that bacteremia was associated with a prolongation of neonatal intensive care unit stay of 14.0 ± 4.0 days (P < .01) and an increase in hospital charges of $25 090 ± 12 051 (P < .05), even after adjustment for birth weight and admission-day SNAP. Conclusions. Nosocomial coagulase-negative bacteremia is an important complication among very low birth weight infants. Assessment of illness severity with SNAP provides information regarding nosocomial infection risk beyond that available from birth weight alone.


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