Increased risk for early hypertriglyceridemia in small for gestational age preterm infants
Intravenous (IV) lipid emulsions are an essential part of the parenteral nutrition in neonatal intensive care units (NICUs). This place the small for gestational age (SGA) preterm infants at higher risk for future metabolic syndrome. There is enough evidence to support the dysregulation of lipid metabolism in growth-restricted fetuses. However, there are fewer data from “real life” cohort studies on SGA infants. The authors Rabinowicz and colleagues (2020) published a study titled “Increased risk for early hypertriglyceridemia in small for gestational age preterm infants” in “The European Journal of Pediatrics”. A summary of the findings is given below:
Objectives:
To examine whether SGA infants are at increased risk for hypertriglyceridemia during treatment with lipid emulsions.
To study the association between hypertriglyceridemia and short-term morbidity.
Method:
The study comprised 71 pairs of preterm infants. Small-for-gestational age infants, 34 weeks’ gestation age born between 2013–2016, were matched and compared with Appropriate-for-gestational age (AGA) equivalents. Triglyceride concentration (> 250 mg/dL) during treatment with parenteral nutrition was considered high.
Findings:
In this largest cohort study of infants with SGA, the investigation reported higher plasma TG concentrations in comparison to Appropriate-for-gestational-age (AGA) infants. The difference was noticed, despite introducing the same amount of IV emulsion. This finding might suggest an altered lipid metabolism mechanism that initiates in intrauterine life and continues later in life and maybe pointed up by lipid consumption. Additionally, fetal programming is one possible factor in the long-term metabolic alteration, which suggests that epigenetic changes followed by an intrauterine insult may result in the development of metabolic syndrome later in life. The study also reports that the plasma TG levels is in inverse proportion with gestational age (GA) and body weight. Prevalence of hypertriglyceridemia was more in SGA infants at a younger age. Though there are previous suggestions that hypoinsulinemia and hypoglycemia can lead to disrupted lipid metabolism in SGA infants, the mechanism for altered TG mechanism in this neonate is unclear. In support of previous reports, the study adds that hypertriglyceridemia was not a significant risk factor for mortality or any of the examined short-term morbidities by using the multivariate logistic regression analysis. On the other hand, the univariate analysis may suggest that rather than its cause, hypertriglyceridemia is a marker of morbidity.
Limitations:
Authors acknowledge that blood samples were taken for clinical rather than research purposes; hence TG levels were not available for all infants born during the study period. Matching more baseline characteristics of the SGA and AGA infants might have improved the strength of the findings, although most relevant variables were found similar between the groups. Besides, there is a lack of information about how long each infant was exposed to hypertriglyceridemia, which may have affected the morbidity analysis. Lastly, the nutritional protocol included a specific lipid emulsion (ClinOleic) together with enteral feeding volumes in SGA infants, both of which are factors that may affect the results.
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