Intravenous lipids in neonates

Abstract

Postnatal growth restriction remains a major issue in high risk preterm neonates and term surgical neonates. Compared to other fields of medicine, development of intravenous lipid emulsion (LE) is quite recent. The first stable LE was introduced in 1960s. Currently typical soybean oil based LE remains the most commonly used intravenous LE in neonatal units. However there are still concerns about the adverse effects of soybean oil LE on immune system, liver metabolism and pulmonary physiology. The risk of infections may also be higher. Newer intravenous LEs are developed from various sources including olive oil, fish oil and combinations of various oils. Although, the newer LEs have potential short-term benefits with regards to laboratory markers such as peroxidation and cytokines as compared to typical soybean oil based LE, there is a lack of data on clinical outcomes and long term effects. This chapter reviews the history and chemistry of and the current evidence for typical soybean oil based LEs. The newer LEs and the data supporting their use in preterm and term neonates are also reviewed.