High-lipid diet soon after birth slows weight loss in VLBW babies

High doses of parenteral lipids during the first week of life eases aggressive weight loss among very low birthweight (VLBW) infants, a new study has found. This feeding regimen may also protect against extra-uterine growth restrictions (EUGR).

Researchers performed a randomized controlled trial including 83 VLBW infants who were given a lipid diet. Those in the intervention group started at a 2-g/kg per day dose of lipids, which was increased to 3 g/kg per day the next day. On the other hand, the control arm started at 0.5–1 g/kg per day of lipid, increasing gradually until reaching the max dose of 3 g/kg per day.

Infants who received the more aggressive lipid diet saw a significantly lower peak percentage weight loss during hospitalization (10.4±3.6 percent vs 12.7±4.6 percent; p=0.02). Weight at birth (p=0.89) and at 36 weeks of corrected age (p=0.11), however, did not significantly differ between arms.

Head circumference (31.3±1.5 vs 30.5±1.4 cm; p=0.05) and its corresponding z-score (–1.09±0.96 vs –1.59±0.98; p=0.04) were both also better in the intervention arm. The development of EUGR was likewise significantly attenuated in the group that received the higher lipid diet (38.6 percent vs 67.6 percent; p=0.009).

As expected, levels of triglyceride were significantly elevated in infants receiving the more aggressive diet (1.91±0.9 vs 1.49±0.5 mmol/L; p=0.007).

These differences, however, did not translate to important clinical differences. Both treatment arms saw comparable rates of hypoglycaemia in the first 7 days, stage ≥2 necrotizing enterocolitis, pulmonary hypertension, and intraventricular haemorrhage, among other such outcomes.

“VLBW infants can tolerate higher dose of parenteral lipid in the first week of age without increased risk of adverse events,” the researchers said. “A larger randomized trial is required to study effects of this regimen on brain structure, body composition, and long-term neurodevelopmental outcomes.”