Recommended Dosing of SMOFlipid in Neonates
The recommended dose of SMOFlipid (lipid emulsion) in neonates is 3.0-4.0 g/kg/day, administered as a continuous infusion over 24 hours. 1
Dosing Guidelines
Initial administration should begin at a lower dose with gradual advancement to minimize the risk of hyperlipidemia 1
- Starting dose: 0.5-1 g/kg/day on day 1 of life
- Gradual increase by 0.5-1 g/kg/day to reach target dose
Maximum recommended dose: 3.0-4.0 g/kg/day for neonates 1
- This is lower than what would be achieved with full enteral feeding but balances nutritional needs with metabolic capacity 1
Continuous infusion over 24 hours is preferred over cyclic administration in neonates 1
- Improves lipid tolerance and clearance
- Reduces risk of hypertriglyceridemia
Monitoring and Adjustments
Monitor serum or plasma triglyceride concentrations regularly, especially in high-risk patients (extremely low birth weight infants, sepsis, catabolic states) 1
Consider reducing lipid dose if triglyceride concentrations during infusion exceed 3 mmol/L (265 mg/dL) in infants 1
Monitor liver function tests to assess for development of parenteral nutrition-associated liver disease 1
Benefits of SMOFlipid vs. Other Lipid Emulsions
SMOFlipid has been associated with reduced risk of cholestasis compared to traditional soybean oil-based emulsions 2, 3
- A meta-analysis showed SMOFlipid significantly reduced cholestasis risk (RR: 0.65,95% CI: 0.48-0.87) 2
SMOFlipid may reduce oxidative stress in preterm neonates 4
- Demonstrated by reduced F2-isoprostane levels (lipid peroxidation marker)
- Increased vitamin E levels provide antioxidant protection
Improved fatty acid profile with SMOFlipid 4
- Better n-6:n-3 ratio (2.5:1) compared to olive oil-based emulsions (9:1)
- Increased eicosapentaenoic acid (EPA) levels
Essential Fatty Acid Requirements
To prevent essential fatty acid deficiency in preterm infants, ensure a minimum linoleic acid (LA) intake of 0.25 g/kg/day 1
For term infants, a minimum LA intake of 0.1 g/kg/day is required 1
The amount of lipid emulsion needed to meet these requirements varies by product:
- With SMOFlipid (composite lipid emulsion with fish oil), approximately 1 g/kg/day is needed to provide adequate LA for preterm infants 1
Special Considerations
Light protection of lipid emulsions is recommended to prevent peroxidation 1
- Use dark delivery tubing and consider administering multi-vitamins containing ascorbic acid together with lipid emulsions
Avoid excessive lipid administration above metabolic capacity (maximal lipid oxidation rate is about 3 g/kg/day in young children) 1
- Excess lipids may be stored in adipose tissue and increase risk of fat overload syndrome