SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: EFFECTS ON CRITICAL DISEASES AND METABOLIC DISORDERS (PART II)

Premature birth and its complications cause stress in newborns, which restrains their physical growth for several weeks after birth and is associated with chronic morbidity and neurological disability in the future. Preterm infants face such difficulties as respiratory distress, cardiovascular disease, gastrointestinal dysfunction and very low birth weight. Most complications in newborns are associated with oxidative stress that develops during the early period of growth. The formation of free radicals entails oxidative damage to many organs and systems of the body and is the main factor responsible for the development of typical diseases of preterm infants, such as bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, and respiratory distress syndrome. Premature infants depend on adequate early parenteral nutrition, which not only guarantees they will survive but also ensures positive health outcomes later in life. Early use of intravenous lipids helps to prevent essential fatty acid deficiencies, provides energy and substrates for cell membrane synthesis, which are important for the growth and development of infants with very low and extremely low birth weight. This publication represents data on the effect of intravenous lipids on critical conditions and metabolic disorders in newborns. Literature sources are analyzed and the existing evidence of the possible influence of lipid emulsions on critical diseases in newborns is presented: intraventricular hemorrhage; necrotizing enterocolitis, patent ductus arteriosus and thrombocytopenia; glucose metabolism (hypo- and hyperglycemia); hyperbilirubinemia and chronic liver damage. The literature review is aimed at finding optimal strategies for the use of lipid emulsions in intensive care of newborns to improve the quality of care for premature infants. The purpose of this work is to analyze the results of published studies and systematize data on the feasibility and safety of lipid emulsions used in newborns with critical diseases of the perinatal period.

SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: CURRENT KNOWLEDGE AND FUTURE PROSPECTS

. Premature birth leads to the developmentof "metabolic shock" in a newborn, the severity of whichis inversely opposite to the weight and gestational age.Infants lose the ability to receive nutrients naturally,transplacentally, and the ability to metabolize mother'smilk is limited due to immaturity. The growth up standardof a prematurely born child is intrauterine growth of thefetal brain and body, which requires not only a sufficientamount of essential nutrients, but also their qualitativecomposition. Nutritional support of premature newborns isa difficult task, especially if infants have perinatal diseasesor require mechanical ventilation, which makes theircatabolic state even worse. Stress limits the child's continuedphysical growth during the first few weeks after birth, andis associated with chronic morbidity and neurologicaldisability in the future. One, and sometimes the only way ofsupplying the main nutrients, is parenteral nutrition, highquality performance of which makes it possible to satisfymost of the nutritional needs of premature babies. In recentyears, high-quality parenteral nutrition protocols have beendeveloped, the adherence to which allows to achieve thegoal. They involve a rather aggressive approach to aminoacid and lipid infusion, but there is still concern about theuse of early parenteral nutrition. Especially restrictionsrelate to intravenous lipids, which are based on severaldogmas, indicating that lipid infusion can be associatedwith the damage of the lungs and liver tissues, as wellas the development of sepsis and thrombosis. There areseveral recent reviews that partially refute these dogmas.In our publication we would like to provide a short basicdata on the safety of lipid emulsions used in newborns, andalso to provide data on the positive effect of lipids on somebiochemical processes and conditions, with an emphasison their features, depending on the composition of the fatemulsion. The literature review can be used to view clinicalpractice, to search for optimal strategies of lipid emulsionsusage, taking into account their chemical components,which will improve the quality of nursing prematureinfants. The purpose of this work is to analyze scientificliterature sources to study and systematize data on modernaspects of the use of lipid emulsions in newborns.

Intravenous Lipids for Preterm Infants: A Review

Extremely low birth weight infants (ELBW) are born at a time when the fetus is undergoing rapid intrauterine brain and body growth. Continuation of this growth in the first several weeks postnatally during the time these infants are on ventilator support and receiving critical care is often a challenge. These infants are usually highly stressed and at risk for catabolism. Parenteral nutrition is needed in these infants because most cannot meet the majority of their nutritional needs using the enteral route. Despite adoption of a more aggressive approach with amino acid infusions, there still appears to be a reluctance to use early intravenous lipids. This is based on several dogmas that suggest that lipid infusions may be associated with the development or exacerbation of lung disease, displace bilirubin from albumin, exacerbate sepsis, and cause CNS injury and thrombocytopena. Several recent reviews have focused on intravenous nutrition for premature neonate, but very little exists that provides a comprehensive review of intravenous lipid for very low birth and other critically ill neonates. Here, we would like to provide a brief basic overview, of lipid biochemistry and metabolism of lipids, especially as they pertain to the preterm infant, discuss the origin of some of the current clinical practices, and provide a review of the literature, that can be used as a basis for revising clinical care, and provide some clarity in this controversial area, where clinical care is often based more on tradition and dogma than science.

Intravenous Lipids: Antidotal Therapy for Drug Overdose and Toxic Effects of Local Anesthetics

Intravenous lipid emulsion is an accepted therapy for the treatment of severe cardiac toxic effects caused by local anesthetics. Lipid emulsion therapy has also been used successfully to treat cardiac arrest and intractable arrhythmias caused by overdoses of antiepileptic drugs, cardiovascular drugs, and psychotropic medications, but experience with intravenous lipids as antidotal therapy in these clinical situations is limited. However, intravenous lipids are relatively safe, widely available, and easy to administer, and many published case reports document their dramatic effectiveness. Patients who have not responded to standard therapies have been quickly revived by administration of intravenous lipids. Use of lipids most likely will increase, and critical care nurses should be familiar with lipid therapy.