Background: Concerns have been raised regarding long-term administration of parenteral nutrition(PN) with intravenous lipid emulsion (lVLE)-induced hyperactivation of the monocyte-macrophage system with hematologic abnormalities, including recurrent thrombocytopenia with reduced platelet lifespan and hemophagocytosis in bone marrow.

Aims: To determine the occurrences of thrombocytopenia in very low birth weight(VLBW) neonates with prolong IVLE in PN.

Methods: All neonates with birth weight < 1500 g and platelets count (PC) >150 × 103 at 24hours were included in study. Neonates who received 1-3g/kg/day IVLE in PN for at least 14days finally formed study group of 56 during January-June 2019 in NICU of Aga khan university hospital, Karachi Pakistan. Recorded PC variation with 14days of IVLE administration.

Results: During the first 7days 41/56 had PC =120 × 103-130 × 103. Total 17/41 had severe sepsis. In 8-14days 20/56 had PC=80 × 103-110 × 103 and 15/20 had severe sepsis. In 8-14days 5/56 had PC < 50 × 103 and required Platelet transfusion, these all 5 neonates had severe sepsis and 2 were treated for fungal infection. All neonates with severe sepsis received meropenem plus vancomycin/meropenem plus colistin. Statistical analysis showed insignificant correlation between the thrombocytopenia and IVLE administration. IVLE was not stopped due to thrombocytopenia and it resolved in all patients with clinical improvement.

Conclusions: These findings suggest that 2 weeks IVLE in 1-3g/kg/day doses has no measurable impact on neonatal platelet count and support its use in neonates even in presence of infection or thrombocytopenia, to provide the adequate energy and essential fatty acids supply in very crucial days of neonatal life.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/use-of-prolong-parenteral-lipid-emulsions-in-nicu-and-hematologic-disorders/