Abstract
Background
Intravenous lipid emulsions are commonly used as a part of parenteral nutrition in premature infants. The potential bilirubin-displacing effects of high free fatty acid (FFA) levels during lipid infusions are known. Levels of free bilirubin (FB) predict the risk of bilirubin neurotoxicity more accurately than indirect serum bilirubin levels. In the present study, we decided to compare the effect of two different lipid solutions on free bilirubin and free fatty acids levels in premature infants.
Methods
Infants were grouped into two groups according to intravenous lipid preparations: Infants in Group 1 received lipid emulsion containing olive oil + soybean oil and Group 2 received containing olive oil + soybean oil + fish oil. The blood samples were gained when lipid intake was 3.5 g/kg/day and FFA and FB levels were analyzed.
Results
Serum FFA and FB levels were similar in groups (p = 0.26 and 0.69 respectively). There were significant correlation between serum FFA and FB levels in Group 1 (r = 0.74, p < 0.001) and in Group 2 (r = 0.92, p < 0.001).
Conclusion
Both lipid preparations seem to have similar effects on free bilirubin and free fatty acid levels in premature newborns.
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Change history
29 July 2022
The ORCID number of the author Mustafa Muhlis Alparslan was corrected to 0000-0001-9759-6629.
References
Nielsen S, Guo Z, Albu JB, Klein S, O’Brien PC, Jensen MD. Energy expenditure, sex, and endogenous fuel availability in humans. J Clin Invest. 2003;111:981–8.
Quehenberger O, Dennis EA. The human plasma lipidome. N Engl J Med. 2011;365:1812–23.
Andrew G, Chan G, Schiff D. Lipid metabolism in the neonate. II. The effect of Intralipid on bilirubin binding in vitro and in vivo. J Pediatr. 1976;88:279–84.
Ruben S, Kleinfeld AM, Richeiri GV, Hiatt M, Hegyi T. Serum levels of unbound free fatty acids, II: the effect of Intralipid administration in premature infants. J Am Coll Nutr. 1997;16:85–87.
Odell GB, Cukier JO, Ostrea EM, Maglalang AC, Poland RL. The influence of fatty acids in the binding of bilirubin to albumin. J Lab Clin Med. 1977;89:295–307. Abstract
Brodersen R. Binding of bilirubin to albumin. CRC Crit Rev Clin Lab Sci. 1980;11:305–99.
Odell GB. Studies in kernicterus I. The protein binding of bilirubin. J Clin Invest. 1959;38:823–33.
Spear ML, Stahl GE, Paul MH, Egler JM, Pereira GR, Polin RA. The effect of 15-hour fat infusions of varying dosage on bilirubin binding to albumin. J Parenter Enter Nutr. 1985;9:144–7.
Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013;162:477–82.
Cashore WJ, Oh W. Unbound bilirubin and kernicterus in low-birth weight infants. Pediatrics. 1982;69:481–5.
Amin SB, Ahlfors CE, Orlando MS, Dalzell LE, Merle KS, Guillet R. Bilirubin and serial auditory brainstem responses in premature infants. Pediatrics. 2001;107:664–70.
Ahlfors CE. Bilirubin-albumin Binding and Free Bilirubin. J Perinatol. 2001;21:S40–2. discussion S59-62
Yokota T, Morioka I, Kodera T, Morisawa T, Sato I, Kawano S, et al. Novel treatment strategy for Japanese newborns with high serum unbound bilirubin. Pediatr Int. 2013;55:54–9.
Morioka I, Nakamura H, Koda T, Sakai H, Kurokawa D, Yonetani M, et al. Serum unbound bilirubin as a predictor for clinical kernicterus in extremely low birth weight infants at a late age in the neonatal intensive care unit. Brain Dev. 2015;37:753–7.
Hulzebos CV, Dijk PH. Bilirubin-albumin binding, bilirubin/albumin ratios, and free bilirubin levels: where do we stand? Semin Perinatol. 2014;38:412–21.
Hegyi T, Kleinfeld A, Huber A, Weinberger B, Memon N, Shi WJ, et al. Effects of soybean lipid infusion on unbound free fatty acids and unbound bilirubin in preterm infants. J Pediatr. 2017;184:45–50.
Nandivada P, Carlson SJ, Cowan E, Chang MI, Gura KM, Puder M. Role of parenteral lipid emulsions in the preterm infant. Early Hum Dev. 2013;89:S45e9.
Yıldızdaş HY, Poyraz B, Atlı G, Sertdemir Y, Mert K, Özlü F, et al. Effects of two different lipid emulsions on antioxidant status, lipid peroxidation and parenteral nutrition- related cholestasis in premature babies, a randomized-controlled study. Pediatr Neonatol. 2019;60:359–67.
Martelanca M, Zibernab L, Passamontib S, Frankoa M. Direct determination of free bilirubin in serum at sub-nanomolar levels. Analytica Chim Acta. 2014;809:174–82.
Amin SB, Harte T, Scholer L, Wang H. Intravenous lipid and bilirubin–albumin binding variables in premature infants. Pediatrics. 2009;124:211–7.
Amin SB. Effect of free fatty acids on bilirubin–albumin binding affinity and unbound bilirubin in premature infants. J Parenter Enter Nutr. 2010;34:414–20.
Ahlfors CE, Amin SB, Parker AE. Unbound bilirubin predicts abnormal automated auditory brainstem response in a diverse newborn population. J Perinatol. 2009;29:305–9.
Nakamura H, Takada S, Shimabuku R, Matsuo M, Matsuo T, Negishi H. Auditory nerve and brainstem responses in newborn infants with hyperbilirubinemia. Pediatrics. 1985;75:703–8.
Amin SB, Charafeddine L, Guillet R. Transient bilirubin encephalopathy and apnea of prematurity in 28 to 32 weeks gestational age infants. J Perinatol. 2005;25:386–90.
Ahlfors CE, Parker AE. Unbound bilirubin concentration is associated with abnormal automated auditory brainstem response for jaundiced newborns. Pediatrics. 2008;121:976–8.
Richard EL, Ammar RB, Tridente A, Luca DD. relationship between transcutaneous bilirubin and circulating unbound bilirubin in jaundiced neonates. Early Hum Dev. 2016;103:235–9.
Odell GB. The distribution and toxicity of bilirubin. Pediatrics 1970;46:16–24.
Van der Schoor LWE, Dijk PH, Verkade HJ, Kamsma ACJ, Schreuder AB, Groen H, et al. Unconjugated free bilirubin in preterm infants. Early Hum Dev. 2017;106-107:25–32.
Acknowledgements
This research was supported by Çukurova University Scientific Research Projects and Turkish Pediatric Association Scientific Projects.
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The authors’ responsibilities were as follows— MS: significantly contributed to research design and concept; HŞ and MKM: significantly contributed to data collection and technical and material support; AT, MKM, FÖ: significantly contributed to data analysis and interpretation; MS, FÖ, HYY: significantly contributed to drafting of the manuscript; MS, FÖ: significantly contributed to the writing paper; HYY, AT: significantly contributed to critical revision of manuscript; MS, FÖ: significantly contributed to final approval and accountability of the paper; MS, FÖ, HYY: significantly contributed to supervision of the paper.
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Satar, M., Şimşek, H., Özlü, F. et al. The effect of different intravenous lipids on free bilirubin levels in premature infants. Eur J Clin Nutr 76, 879–882 (2022). https://doi.org/10.1038/s41430-021-01049-3
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DOI: https://doi.org/10.1038/s41430-021-01049-3