Docosahexaenoic and Arachidonic Acid Levels in Extremely Low Birth Weight Infants with Prolonged Exposure to Intravenous Lipids

Objective To report changes in red blood cell long-chain polyunsaturated fatty acids levels in extremely low birth weight (ELBVV) infants relative to duration of intravenous lipid emulsion. Study design Serial blood samples were collected from 26 ELBW infants during the first 2 months of life in the neonatal intensive care unit using a prospective cohort study design. The primary outcome was the change in long-chain polyunsaturated fatty acids levels over the study period relative to a duration of intravenous lipid emulsion of either <= 28 days or >28 days. Secondary outcomes included parenteral and enteral nutritional exposures as well as prematurity-associated morbidities. Longitudinal regression estimated changes in fatty acid levels between the 2 exposure groups. Results Infants with >28 days intravenous lipid emulsion had 36 more days of intravenous lipid emulsion than did those with <= 28 days (P < .001). Docosahexaenoic acid significantly decreased over time in all infants and decreased significantly more in infants exposed to intravenous lipid emulsion for >28 days (P = .03). Arachidonic acid significantly decreased over the study period but the decrease was not related to intravenous lipid emulsion duration. Linoleic and a-linolenic acids had significantly larger increases over time in those with longer exposure to intravenous lipid emulsion (P < .01). Conclusion Docosahexaenoic acid status of ELBW infants declined significantly in the first 2 months of life and the decline was significantly greater in those exposed to intravenous lipid emulsion >28 days compared with those exposed 28 day's. (J Pediatr 2013;162:56-61).