High Early Parenteral Lipid in Very Preterm Infants: A Randomized-Controlled Trial (HELP trial).

Abstract Objective To determine whether high early parenteral soybean oil lipid intake in very low birth weight (VLBW) infants in the first week after birth decreases the proportion of weight loss and subsequently the incidence of extra-uterine growth restriction (EUGR). Study design This was a randomized controlled trial of appropriate-for-gestational-age VLBW infants. Lipid intake in the control group started at 0.5-1 g/kg per day and increased daily by 0.5-1 g/kg per day till reaching 3 g/kg per day. The intervention group was started on 2 g/kg per day which increased to 3 g/kg per day the following day. Results Of the 176 infants assessed for eligibility, 83 were included in the trial. Infants in the intervention group were started on lipid sooner (13.8±7.8 vs 17.5±7.8 h; P= 0.03) and had higher cumulative lipid intake in the first 7 days of age (13.5±4.2 vs. 10.9±3.5 g/kg per day; P = .03). Infants in the intervention group had a lower percentage of weight loss (10.4 vs. 12.7%; P= 0.02). The mean triglyceride level was higher in the intervention group (1.91±0.79 vs. 1.49±0.54 mmol/L; P= 0.01), however, hypertriglyceridemia was similar between the two groups. The incidence of EUGR was lower in the intervention group (38.6% vs. 67.6%; P= 0.01). Head circumference Z-score was higher in the intervention group (-1.09±0.96 vs. -1.59±0.98; P= 0.04). Conclusion In VLBW infants, provision of a high early dose of parenteral lipid in the first week of age results in less weight loss and lower incidence of EUGR.