Pediatr Gastroenterol Hepatol Nutr.  2013 Jun;16(2):116-122.

Clinical Factors Affecting Lipid Metabolism and Optimal Dose of Heparin in Preterm Infants on Parenteral Nutrition

• Lim MS
• Choi CW
• Kim BI
• Yang HR

Abstract

PURPOSE
Preterm infants on parenteral nutrition are at a relatively high risk for hypertriglyceridemia because they have immature lipoprotein lipase activity. The purpose of this study was to analyze the clinical factors affecting lipid metabolism in preterm infants receiving parenteral nutrition and to evaluate the influence of intravenous heparin on serum triglycerides to determine the adequate heparin dose to prevent hypertriglyceridemia in preterm infants.
METHODS
A single-center retrospective review was conducted among preterm infants receiving parenteral nutrition between January 2006 and February 2011. In 75 patients, 110 determinations were performed within 28 days postnatal age. Demographic and clinical data, including laboratory parameters, the dose and the duration of lipid administration, and the amount of intravenous heparin, were analyzed.
RESULTS
Serum triglycerides were higher in the small for gestational age (SGA) infants than in the appropriate for gestational age infants (185.5+/-134.9 mg/dL vs. 126.9+/-101.9 mg/dL, p=0.019). Birth weight, gestational age, and body weight were negatively correlated with serum triglyceride level (r=-0.289, p=0.002; r=-0.208, p=0.029; r=-0.287, p=0.002, respectively). The serum triglyceride level was statistically lower in preterm infants receiving 1 U/mL of heparin than in those receiving 0.5 U/mL heparin or no heparin.
CONCLUSION
Preterm infants receiving parenteral nutrition, particularly SGA and extremely low birth weight infants, tend to have hypertriglyceridemia. Thus, administration of 1 U/mL of heparin rather than 0.5 U/mL or none may be helpful to prevent hypertriglyceridemia in preterm infants.

Keyword

Lipids; Hypertriglyceridemia; Parenteral nutrition; Heparin; Preterm infant

MeSH Terms

Birth Weight
Body Weight
Gestational Age
Heparin
Humans
Hypertriglyceridemia
Infant
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Lipid Metabolism
Lipoprotein Lipase
Parenteral Nutrition
Retrospective Studies
Triglycerides
Heparin
Lipoprotein Lipase
Triglycerides

Figure

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  Fig. 1 Flowchart of patient recruitment and allocation. ELBW: extremely low birth weight, VLBW: very low birth weight, LBW: low birth weight, AGA: appropriate for gestational age, SGA: small for gestational age, TG: triglyceride.

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  Fig. 2 Comparison of serum triglyceride (TG) levels between appropriate for gestational age (AGA) and small for gestational age (SGA) infants. The mean serum TG levels were 126.9±101.9 mg/dL in AGA and 185.5±134.9 mg/dL in SGA infants (p=0.019).

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  Fig. 3 Trend of serum triglyceride (TG) levels based on lipid administration. Serum TG levels were higher in extremely low birth weight (ELBW) infants than in the other 2 groups, especially with low dose lipid (<2 g/kg/day). VLBW: very low birth weight, LBW: low birth weight.

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  Fig. 4 Serum triglyceride (TG) levels among the 3 groups based on the amount of heparin: medians and interquartile range. The serum TG concentration was significantly lower in the 1 U/mL heparin group than in the 0.5 U/mL group or the no heparin group. The serum TG levels were not significantly different in the 0.5 U/mL heparin and no heparin groups.

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