1. 1-3g/kg/day (5-15ml/kg/day) 20% Intralipid solution
   Dose usually commenced at 1g/kg/day, and increased to 2g/kg/day and then 3g/kg/day on successive days.
   Needs to be ordered for individual babies on a daily basis.
2. Doses up to 4g/kg/day (20ml/kg/day) can be given in infants who require additional calories
3. Intralipid is usually prescribed as a multiple of 2.4ml (increments of 0.1ml/hour via infusion pumps).

Indications

1. Infants requiring intravenous nutrition because of contraindications to feeding.  VLBW premature infants develop biochemical evidence of essential fatty acid insufficiency within 3 days of fat-free nutrition
2. Low doses (1g/kg/day) of intravenous lipid should be started within 3 days of starting intravenous nutrition (but can be commenced on the first day),

Contraindications and Precautions

1. Jaundice
   • Hyperlipidaemia may displace bilirubin from albumin, thereby increasing free bilirubin and increasing the risks of jaundice.  In the presence of significant jaundice, restriction or reduction of lipid intake should be considered.
2. Sepsis
   • Lipid emulsion may impair neutrophil function.  In infants who are septic, consideration should be given to restricting or reducing lipid intake.

Clinical Pharmacology

20% Intralipid is an emulsion of soybean oil trigylcerides, stabilised with egg yolk phospholipids.

• 5ml of 20% Intralipid provides 1g of fat and 10kcal of energy.

Possible Adverse Effects

1. Local infiltration if administered via a peripheral IV.
2. Pulmonary deterioration from too rapid infusion.
3. Intralipid is highly susceptible to oxidation causing lipid hydroperoxides which are cytotoxic.  Elevated levels can be formed during clinical use in ambient light, especially when intralipid infusion is combined with phototherapy.  This may be prevented by covering the intralipid by aluminium foil during light exposure. ¹
4. Complications related to central line access.

Special Considerations

1. It is not our usual practice to routinely monitor triglyceride levels in infants receiving Intralipid infusions.
2. Consider reducing Intralipid intake in the presence of jaundice or sepsis.

Preparation

• 20% Intralipid™ is the preparation currently in use.
• 5ml = 1g = 10kcal
• Supplied as a pre-packaged syringe labelled for the individual baby.
• Vitamins may be added if the infant is receiving more than 1g/kg/day of intralipid and if the baby is receiving <30% of their intake as enteral feeds.
• Other preparations of lipid emulsions are available. However, there are few data available as yet to support the clinical use of any one preparation over another.

Administration

• Preferentially administered centrally, using a Y-connector with amino acid solution.
• Usually administered over 24 hours (but can be administered ≥20 hours).
• Must be protected from light. This can be done using aluminium foil or light-protecting tubing.

Storage

• Stored in fridge in NICU.
• Can be stored at room temperature when in use.

References

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