[Current status of parenteral feeding with fat infusions. Clinical experiences with premature and newborn infants].

By administration of fat emulsion a well-balanced parenteral nutrition concerning calories is possible in newborn infants. Investigations with great amounts of fat during and after a short-time infusion have shown that the maximal fat clearance of very-low-birth-weight and small-for-gestational-age newborn infants is limited. Heparin can improve the lipid clearance and reduce hyperlipaemia occurring under lipid application. The fat oxidation is not affected by heparinization. Extent and velocity of the fatty acid utilization can be judged by the 13C-triolein breath test. Under the clinical conditions of a continuous long-term infusion with 2 g fat/kg BW/day a complete fat clearance is observed in low-birth-weight infants with respiratory distress syndrome and septicaemia and small-for-gestational-age newborn infants. The determination of serum triglycerides is considered to be a sufficient control of fat clearance in respect to clinical concerns. The fat emulsion is continuously applied for 24 h and is being increased stepwise up to a dosage of 2-3 g/kg BW/day. Before starting parenteral nutrition, acidosis, hypoxaemia, hyperglycaemia and insufficient circulation must have been treated. Contraindications to this are shock, disturbances of blood coagulation and of fat metabolism. Complications are avoided by using an adapted and standardized nutritional programme under sufficient clinical and laboratory control.