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Dilemmas in the delivery of intravenous lipid emulsions and approach to hypertriglyceridemia in very preterm and low birth weight infants


Intravenous lipid emulsions (ILEs) are an essential component of parenteral nutrition for very preterm and very low birth weight infants (VLBWs). This article offers a perspective on advancements and controversies on ILE use in this population. ILEs prescribed after birth at a dose of 1.5–2 g/kg/day and advanced to 3 g/kg/day enhance growth. Growth appears to be similar for infants who receive an ILE composed of 100% soybean oil or a multi-oil ILE with 15% fish oil. 100% fish oil is the preferred ILE for the management of parenteral nutrition associated cholestasis and intestinal failure associated liver disease. Research is warranted to help determine how we can optimize ILEs to improve neurodevelopment and prematurity complications. Last, we lack a universal definition of hypertriglyceridemia (HTG) and consensus on triglyceride surveillance and HTG management. Investigation is required to determine the health impact of specific triglyceride ranges in very preterm infants and VLBWs.

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Fig. 1: Triglyceride metabolism.

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BF and KLC drafted the initial manuscript. All authors edited, critically reviewed, and approved the manuscript, and agree to be accountable for the contents of the manuscript.

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Correspondence to Kara L. Calkins.

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Competing interests

BF is an advisor and speaker for Mead Johnson Nutrition. CRM serves on the Scientific Advisory Board of Plakous Therapeutics, Vitara Biomedical, and LactaLogics, Inc. KLC has served as an advisor for Fresenius Kabi, Mead Johnson Nutrition, Baxter, and Prolacta. CRM and KLC serve as institutional principal investigators, with no salary funding, for a consortium database sponsored by Mead Johnson Nutrition.

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Frost, B., Martin, C.R. & Calkins, K.L. Dilemmas in the delivery of intravenous lipid emulsions and approach to hypertriglyceridemia in very preterm and low birth weight infants. J Perinatol 43, 1189–1193 (2023).

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