Microbial Growth in Neonatal Intravenous Fat Emulsion Administered Over 12 Versus 24 Hours

OBJECTIVES To determine whether an extended infusion time (24 hours) of intravenous fat emulsion is associated with an increase in microbial growth, versus a shorter infusion time (12 hours). METHODS Samples were collected from intravenous fat emulsions (n=132), from intravenous fat emulsions prepared in the current 24-hour infusion method (n=55), and from intravenous fat emulsions prepared in the twice-daily (12-hour infusion) method (n=55). In addition, samples were collected from pharmacy (n=22) to test for possible contamination. RESULTS No growth was observed in either arm of the study. CONCLUSIONS Current Kern Medical Center policy of preparation and administration of neonatal intensive care unit intravenous fat emulsion is safe and effective in regard to microbial growth.

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Drs. Cashore and Usher Reply

PEDIATRICS ◽

10.1542/peds.58.6.917a ◽

1976 ◽

Vol 58 (6) ◽

pp. 917-918

Author(s):

William J. Cashore ◽

Robert H. Usher

Keyword(s):

Premature Infants ◽

Growth Rates ◽

Early Growth ◽

Fat Emulsion ◽

Metabolic Complications ◽

Intravenous Fat Emulsion ◽

Autopsy Findings ◽

Fat Emulsions ◽

Intravenous Fat Emulsions

We are indeed interested to learn that Higgs et al.1 have achieved early growth rates comparable to those in our study with the use of intravenous fat emulsion in small premature infants. Further information on the metabolic complications and autopsy findings encountered in their study would provide important additional evidence concerning the effectiveness and potential hazards of using intravenous fat emulsions in sick newborns. There was a difference between the two studies in the method of infusing the fat emulsion.

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Microbial Growth Patterns in Intravenous Fat Emulsions

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/40.10.1650 ◽

1983 ◽

Vol 40 (10) ◽

pp. 1650-1653 ◽

Cited By ~ 2

Author(s):

David Keammerer ◽

C. Glen Mayhall ◽

Gaye O. Hall ◽

Lawrence J. Pesko ◽

Robert B. Thomas

Keyword(s):

Microbial Growth ◽

Growth Patterns ◽

Fat Emulsions ◽

Intravenous Fat Emulsions

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Growth of Microorganisms in Total Nutrient Admixtures

Drug Intelligence & Clinical Pharmacy ◽

10.1177/1060028087021007-814 ◽

1987 ◽

Vol 21 (7-8) ◽

pp. 633-638 ◽

Cited By ~ 21

Author(s):

Carl E. Rowe ◽

Thomas T. Fukuyama ◽

James T. Martinoff

Keyword(s):

Amino Acids ◽

Staphylococcus Aureus ◽

Trace Elements ◽

Parenteral Nutrition ◽

Microbial Growth ◽

Fat Emulsion ◽

Gram Negative ◽

Colony Forming Units ◽

All Solutions ◽

Intravenous Fat Emulsions

It has been reported that intravenous fat emulsions, because of their isotonicity and neutral pH, support microbial growth, but traditional parenteral nutrition solutions, being hypertonic and more acidic, are not as supportive. To date, few studies have documented microbial growth in total nutrient admixtures (TNA) containing dextrose, amino acids, fat, electrolytes, vitamins, and trace elements. This study was undertaken to analyze the growth of Staphylococcus aureus, Candida albicans and four gram-negative enteric bacilli in three different nutrient admixtures, with and without the inclusion of 5% fat emulsion. The composition of the admixtures was either 5, 10, or 25% dextrose; either 0 or 5% fat; and 3% amino acids, electrolytes, vitamins, and trace elements. All admixtures were innoculated with 100 colony-forming units per milliliter, incubated at room (25°C) or refrigerated (4°C) temperature, with samples withdrawn at 0, 3, 6, 12, 24, and 48 hours and plated in triplicate. Only C. albicans demonstrated any significant growth regardless of fat content. The pH of the admixtures was similar (acidic), and all solutions were hypertonic and found to inhibit bacterial growth. Conclusions suggest that TNA, when formulated with normal concentrations of additives, is no more likely to support growth of contaminant organisms than the traditional solutions. This contradicts the notion that the addition of fat to total parenteral nutrition will enhance the ability of these admixtures to support microbial growth.

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Intravenous Fat Emulsions and Lung Function : A Review B. SKEIE, J. ASKANAZI, M. ROTHKOPF, S. ROSENBAUM, V. KVETAN, AND B. THOMASHOW Departments of Anesthesiology and Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; the Department of Medicine, VA Medical Center, East Orange, New Jersey; Departments of Anesthesiology and Medicine, Albert Einstein College of Medicine, Bronx, New York

Nutrition in Clinical Practice ◽

10.1177/088453368800300409 ◽

1988 ◽

Vol 3 (4) ◽

pp. 157-157

Author(s):

Denise B. Schwartz

Keyword(s):

New York ◽

New Jersey ◽

Lung Function ◽

Medical Center ◽

Albert Einstein College ◽

Albert Einstein ◽

Columbia University ◽

Fat Emulsions ◽

Intravenous Fat Emulsions

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State of the Art Review: Intravenous Fat Emulsions: Current Applications, Safety Profile, and Clinical Implications

Annals of Pharmacotherapy ◽

10.1345/aph.1m626 ◽

2010 ◽

Vol 44 (4) ◽

pp. 688-700 ◽

Cited By ~ 90

Author(s):

Jay M Mirtallo ◽

Joseph F Dasta ◽

Kurt C Kleinschmidt ◽

Joseph Varon

Keyword(s):

Safety Profile ◽

State Of The Art ◽

Clinical Implications ◽

Fat Emulsions ◽

Intravenous Fat Emulsions

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Use of Intravenous Fat Emulsions in Surgical Patients

Surgical Clinics of North America ◽

10.1016/s0039-6109(16)35691-2 ◽

1959 ◽

Vol 39 (1) ◽

pp. 145-159 ◽

Cited By ~ 5

Author(s):

Frederick W. Preston ◽

George C. Henegar

Keyword(s):

Surgical Patients ◽

Fat Emulsions ◽

Intravenous Fat Emulsions

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A Randomized Trial of Micropreemies Receiving Higher Amounts of Intravenous Fat Emulsion During the First Week of Life

ICAN Infant Child & Adolescent Nutrition ◽

10.1177/1941406411429847 ◽

2011 ◽

Vol 4 (1) ◽

pp. 58-66

Author(s):

Douglas Drenckpohl ◽

Matthew Niehaus ◽

Catherine Schneider ◽

Connie McConnell ◽

Huaping Wang ◽

...

Keyword(s):

Randomized Trial ◽

Fat Emulsion ◽

Intravenous Fat Emulsion

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Intravenous Alimentation and Insensible Water Loss in Low-Birth- Weight Infants

PEDIATRICS ◽

10.1542/peds.63.4.543 ◽

1979 ◽

Vol 63 (4) ◽

pp. 543-546

Author(s):

Keith H. Marks ◽

Timothy P. Farrell ◽

Zvi Friedman ◽

M. Jeffrey Maisels

Keyword(s):

Amino Acid ◽

Acid Solution ◽

Water Loss ◽

Caloric Intake ◽

Constant Infusion ◽

Fat Emulsion ◽

Low Birth Weight Infants ◽

Amino Acid Solution ◽

Intravenous Fat Emulsion ◽

Multiple Measurements

Insensible water loss (IWL) was measured in six premature infants, betWeen 4 and 21 days of age, by continuous weight monitoring on an electronic balance inside an incubator. Multiple measurements of IWL were made during the sequential infusion of 10% dextrose in 0.225% NaCl, 10% dextrose-amino acid solution, or 10% dextrose-amino acid and a commercial intravenous fat emulsion. Each solution was administered for three hours by constant infusion through a scalp vein needle. The order of the infusion was random and a 30-to 60-minute infusion with 5% dextrose water was given between each solution. During the infusion of 10% dextrose in 0.225% NaCl and 10% dextrose + amino acid solution, IWL was 1.0 ± 0.8 gm/kg/ hr and 1.1 ± 0.8 gm/kg/hr, respectively. In contrast, IWL increased significantly to 1.6 ± 0.7 gni/kg/hr when additional calories were given using the 10% dextrose-amino acid with the intravenous fat emulsion (P < .005). There was a positive correlation between caloric intake and IWL. These data suggest that parenteral nutrition solutions with intravenous fat emulsion are rapidly metabolized and the increase in IWL is probably secondary to an increase in thermogenesis.

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