Unbound free fatty acids from preterm infants treated with intralipid decouples unbound from total bilirubin potentially making phototherapy ineffective

Thomas Hegyi; Suganya Kathiravan; Gary E. Stahl; Andrew H. Huber; Alan Kleinfeld

doi:10.1159/000349995

Unbound free fatty acids from preterm infants treated with intralipid decouples unbound from total bilirubin potentially making phototherapy ineffective

Thomas Hegyi, Suganya Kathiravan, Gary E. Stahl, Andrew H. Huber, Alan Kleinfeld

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

Extremely low birth weight (ELBW; <1,000 g) infants have poor outcomes, often compromised by bilirubin neurotoxicity. We measured unbound bilirubin (B_f) and unbound free fatty acid (FFA_u) levels in 5 ELBW infants in a trial examining the effects of pharmacologic ductal closure on infants treated with Intralipid infusion (3 g/kg/day). The levels for all infants (mean ± SD) were: total serum bilirubin (TSB) 4.6 ± 1.7 mg/dl, FFA_u 376 ± 496 nM, and B_f 42 ± 30 nM. Of the 3 infants who died, 2 had TSB <5.9 mg/dl but FFA_u >580 nM and B_f >75 nM. Multiple regression revealed a major effect on B_f levels due to FFA_u, indicating that Intralipid elevated levels of FFA_u and B_f. Indomethacin or ibuprofen reduced B_f levels, most likely by reducing FFA_u levels through lipase inhibition. Because displacement of B_f by FFA_u decouples B_f from TSB, phototherapy may not reduce the risk of bilirubin or FFA_u toxicity in Intralipid-treated ELBW infants.

Original language	English (US)
Pages (from-to)	184-187
Number of pages	4
Journal	Neonatology
Volume	104
Issue number	3
DOIs	https://doi.org/10.1159/000349995
State	Published - Sep 2013

All Science Journal Classification (ASJC) codes

Pediatrics, Perinatology, and Child Health
Developmental Biology

Keywords

Extremely low birth weight infants
Ibuprofen
Indomethacin
Intralipid
Outcome
Phototherapy
Unbound bilirubin
Unbound free fatty acids

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10.1159/000349995

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title = "Unbound free fatty acids from preterm infants treated with intralipid decouples unbound from total bilirubin potentially making phototherapy ineffective",

abstract = "Extremely low birth weight (ELBW; <1,000 g) infants have poor outcomes, often compromised by bilirubin neurotoxicity. We measured unbound bilirubin (Bf) and unbound free fatty acid (FFAu) levels in 5 ELBW infants in a trial examining the effects of pharmacologic ductal closure on infants treated with Intralipid infusion (3 g/kg/day). The levels for all infants (mean ± SD) were: total serum bilirubin (TSB) 4.6 ± 1.7 mg/dl, FFAu 376 ± 496 nM, and Bf 42 ± 30 nM. Of the 3 infants who died, 2 had TSB <5.9 mg/dl but FFAu >580 nM and Bf >75 nM. Multiple regression revealed a major effect on Bf levels due to FFAu, indicating that Intralipid elevated levels of FFAu and Bf. Indomethacin or ibuprofen reduced Bf levels, most likely by reducing FFAu levels through lipase inhibition. Because displacement of Bf by FFAu decouples Bf from TSB, phototherapy may not reduce the risk of bilirubin or FFAu toxicity in Intralipid-treated ELBW infants.",

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AU - Hegyi, Thomas

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AU - Huber, Andrew H.

AU - Kleinfeld, Alan

PY - 2013/9

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AB - Extremely low birth weight (ELBW; <1,000 g) infants have poor outcomes, often compromised by bilirubin neurotoxicity. We measured unbound bilirubin (Bf) and unbound free fatty acid (FFAu) levels in 5 ELBW infants in a trial examining the effects of pharmacologic ductal closure on infants treated with Intralipid infusion (3 g/kg/day). The levels for all infants (mean ± SD) were: total serum bilirubin (TSB) 4.6 ± 1.7 mg/dl, FFAu 376 ± 496 nM, and Bf 42 ± 30 nM. Of the 3 infants who died, 2 had TSB <5.9 mg/dl but FFAu >580 nM and Bf >75 nM. Multiple regression revealed a major effect on Bf levels due to FFAu, indicating that Intralipid elevated levels of FFAu and Bf. Indomethacin or ibuprofen reduced Bf levels, most likely by reducing FFAu levels through lipase inhibition. Because displacement of Bf by FFAu decouples Bf from TSB, phototherapy may not reduce the risk of bilirubin or FFAu toxicity in Intralipid-treated ELBW infants.

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Unbound free fatty acids from preterm infants treated with intralipid decouples unbound from total bilirubin potentially making phototherapy ineffective

Abstract

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