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The Effect of 15-Hour Fat Infusions of Varying Dosage on Bilirubin Binding to Albumin

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Gary E. Stahl, M.D.

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Mary H. Paul, R.N.

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Joseph M. Egler, B.A.

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Gilberto R. Pereira, M.D.

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Richard A. Polin, M.D.

Division of Neonatology of the Children's Hospital of Philadelphia and the Department of Pediatrics of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Intravenous fat emulsions (1, 2, and 3 g/kg) were administered over 15 hr to 20 appropriate for gestational age premature infants with physiologic hyperbilirubinemia to determine the effect of fat infusions on the serum free fatty acid:albumin molar ratio (F/A) and on unbound bilirubin. Significant increases (p < 0.05) in F/A occurred with each increase in lipid dose in infants < 30 wk gestation, but not in infants 30 wk gestation. There was a direct linear correlation (r = 0.65, p < 0.001) between F/A ratio and unbound bilirubin (estimated fluorometrically by the ratio of albumin-bound bilirubin/reserve bilirubin binding capacity, B/R). The largest increases in unbound bilirubin (albumin-bound bilirubin/reserve bilirubin binding capacity) were seen in infants with F/ A > 4.0. The gestational age of infants with F/A > 4.0 was significantly less (p < 0.01) than infants with F/A < 4.0 (28.7 ± 0.47 us. 31.1 ± 0.40 wk, mean ± SEM). In 10/58 infusions there was a fall in unbound bilirubin, unrelated to birthweight, gestational age, postnatal age, however, during these infusions the end-infusion F/A was 3.0. We conclude that 1 g/kg of lipid emulsion infused over a 15-hr period has minimal risk of decreasing bilirubin binding in premature infants < 30 wk gestation. As doses of 2 or 3 g/kg are used, these infants may be at risk of decreased bilirubin binding, due to elevations in the F/A ratio. Monitoring of the F/A ratio may identify infants at risk for decreased bilirubin binding during lipid infusion and provide guidelines for determining the appropriate lipid dose. (Journal of Parenteral and Enteral Nutrition 9:144-147, 1985)

Journal of Parenteral and Enteral Nutrition, Vol. 9, No. 2, 144-147 (1985)
DOI: 10.1177/0148607185009002144


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