The Use of Intravenous Fat Emulsions in Preterm Infants
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چکیده
The first intravenous fat (IVF) preparation used to any great extent in the United States was made from cottonseed oil and marketed under the tradename of Lipomul®. A great deal of experience was gained with the use of this emulsion and, in fact, an entire symposium was published reviewing the data regarding this agent (Metabolism, 6:591-831, 1957). Lipomul® was withdrawn from the market in 1965 because of numerous reports of toxicity, including "the fat-overloading syndrome", hemorrhagic tendencies, and liver damage. The toxic accumulation of fat observed with Lipomul® was attributed to its large particle size (1 n in diameter), and possibly the emulsifying agent, pluronic F-68 (46,76). In 1961 Schuberth and Wretlind described the use of a parenteral fat emulsion made from soybean oil (65), and in 1981 Wretlind reported that in Sweden over 1.6 million units of this emulsion, Intralipid®, were infused with only 8 cases of suspected untoward reaction. In only one case was a causal relationship probable (79). After Intralipid® had been used extensively in Europe and Canada, it was finally approved by the FDA for use in the United States in 1975. In 1979 Liposyn® became available in the United States, and, more recently, a third fat preparation, Travamulsion®, has also been released for use. Intralipid® and Travamulsion® contain soybean oil as a base, while Liposyn® is made from safflower oil. Each product uses purified egg phospholipid as an emulsifier, each contains glycerin to make the solutions isotonic, and, when metabolized appropriately, each will yield 1.1 cal./ml. Table 1 lists the make-up and notes the differences in each of the products. The particle size of Intralipid® is 0.5 n while those of Liposyn® and Travamulsion® are 0.4 n. Both Intralipid® and Travamulsion® contain linolenic acid in significant amounts—8% and 6% respectively; less than 0.5% of this fatty acid is found in Liposyn®. Until recently, linolenic acid deficiency had been recognized only in trout (80) and rats (41), but a 6-year-old child who had received a linolenic-free diet for 5 months developed neurological symptomatology including numbness, weakness, leg pain, and blurring of vision (37). Her symptoms disappeared when she was given linolenic acid via an infusion
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Metabolic effects of intravenous lipid emulsions based on LCT (soybean oil) or LCT/MCT (soybean oil/coconut oil) in preterm infants
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تاریخ انتشار 2006