Extrauterine Growth Restriction: What Is the Evidence for Better Nutritional Practices in the Neonatal Intensive Care Unit?

Dana Lunde, DNP RNC APRN NNP-BC

Disclosures

NAINR. 2014;14(3):92-98. 

In This Article

Early Administration of Intralipids

Like the administration of early amino acids the fear of early intralipid administration also exists but for different reasons. The use of intralipids has been reported to be associated with chronic lung disease and lung injury as well as an increased risk for kernicterus; however, two systematic reviews have shown that no adverse effects were demonstrated in the RCTs that were reviewed.[10]

Simmer and Roa conducted a systematic review to determine the safety and efficacy of administering intralipids within the first five days of life to premature infants who were receiving parenteral nutrition only. The review contained five RCTs, which showed no significant effects of administering intralipids within the first five days of life on short-term nutrition or other clinical outcomes. The authors could not recommend early administration of intralipids for short-term growth.[25]

A more recent systematic review was conducted to summarize the effects of administering intralipids within the first two days of life on growth and morbidities on VLBW infants.[26] Vlaardingerbroek and colleagues examined 14 RCTs and concluded that the early administration of intralipids within the first two days of life was safe and well tolerated. But, no beneficial effects on growth were found with the early administration of intralipids.[26]

Evidence from both of these systematic reviews suggests that early administration of intralipids is safe and has no adverse effects but does not affect short or long-term growth. However, evidence from Wilson et al.[16] Ibrahim and colleagues[17] and Morgan and associates[18] found that early administration of intralipids as part of an early aggressive nutrition plan did promote short-term growth. Therefore, intralipids should only be administered along with early amino acids and minimal enteral feedings to promote adequate postnatal growth in small premature infants.

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