SMOF Dosing in Neonates
The recommended dosing for SMOFlipid in neonates is 0.5-3.5 g/kg/day, with gradual increases from an initial dose of 0.5-1 g/kg/day to a maximum of 3-3.5 g/kg/day by day 3-4 of therapy. 1
Dosing Guidelines
- Initial dosing should start at 0.5-1 g/kg/day on day 1 of parenteral nutrition therapy 1
- Dose should be gradually increased over 2-3 days to reach the target dose 1
- Maximum recommended dose is 3-3.5 g/kg/day by day 3-4 of therapy 1
- Infusion rate should not exceed 0.15 g/kg/hour 1
Administration Considerations
- SMOFlipid should be administered as a continuous infusion through a peripheral or central vein 1
- Administration through a dedicated line is preferred to avoid compatibility issues with other medications 1
- Careful monitoring of liver function tests is recommended during therapy due to potential for cholestasis, though SMOFlipid has shown reduced risk of cholestasis compared to other lipid emulsions 1
Clinical Benefits of SMOFlipid
- SMOFlipid significantly reduces the risk of cholestasis compared to other lipid emulsions (risk ratio: 0.65,95% CI: 0.48-0.87) 1
- In extremely premature infants (gestational age <28 weeks), SMOFlipid has been shown to reduce the incidence of patent ductus arteriosus (RR: 0.88,95% CI: 0.79-0.99) 1
- No significant differences have been observed in rates of sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, or intraventricular hemorrhage compared to other lipid emulsions 1
Monitoring Parameters
- Liver function tests should be monitored regularly during therapy 1
- Triglyceride levels should be monitored, particularly when increasing the dose 1
- If triglyceride levels exceed 250 mg/dL, consider reducing the dose or temporarily discontinuing the infusion 1
Special Considerations
- In extremely premature infants (<28 weeks gestation), closer monitoring may be required due to immature metabolic systems 1
- In infants with existing liver dysfunction, lower initial doses and slower advancement may be necessary 1
- SMOFlipid may be particularly beneficial for infants at high risk of cholestasis or those requiring long-term parenteral nutrition 1
Common Pitfalls and Caveats
- Avoid rapid infusion rates which may lead to fat overload syndrome characterized by hyperlipidemia, fever, and hepatomegaly 1
- Do not exceed recommended maximum doses as this may increase the risk of adverse effects 1
- Ensure proper preparation and storage of the emulsion to maintain stability 1
- Monitor for signs of infection at the infusion site, as lipid emulsions can support microbial growth 1