The effects of multiple trace elements injection (I) on the stability of fat emulsion in neonatal parenteral nutrition solutions / 中华临床营养杂志

ABSTRACT

Objective:To investigate the effects of multiple trace elements in neonatal parenteral nutrition (PN) on the stability of fat emulsion, and to assess the changes of stability indexes after filtration.Methods:With the standard body weight of 1.5 kg, seven groups of neonatal PN solutions with different concentrations of multiple trace elements were designed, including blank group (without multiple trace elements), normal dose group (1 ml/kg, i.e., 0.75 ml per 100 ml PN) and five experimental groups (i.e., 1.5 ml, 3 ml, 4.5 ml, 6 ml, and 7.5 ml per 100 ml PN respectively). Macroscopic observation was performed 0 h and 24 h after preparation. The mean droplet diameter (MDD) of lipid emulsion was determined with dynamic light scattering before and after filtration. The percentage of fat residing in globules larger than 5 μm (PFAT5) and the globule size distribution before and after filtration were determined with light blockage method.Results:Macroscopic examination of the 7 groups of PN solutions identified neither changes in color nor stratification within 24 hours after solution preparation. Within 24 hours after solution preparation, the MDDs of all PN solutions before filtration were between (338.67±6.11) nm and (370.00±15.13) nm, and the PFAT5 values before filtration ranged from (32.00±1.00) ×10 -3% to (85.67±6.81) ×10 -3%. The MDDs of all PN solutions after filtration were between (310.67±8.62) nm and (362.33±19.86) nm, and the PFAT5 values after filtration ranged from (4.67±1.15) ×10 -3% to (17.33±0.58) ×10 -3%. The concentration of multiple trace elements was positively correlated with PFAT5 ( P<0.05). There was statistically significant difference in PFAT5 values at 0 h and 24 h after preparation ( P=0.004). The difference of PFAT5 values before and after filtration was also statistically significant ( P=0.000). Conclusions:Within 24 hours after solution preparation at room temperature, the appearance of neonatal PN solutions with different concentrations of trace elements supplementation was unchanged, and the MDDs of fat emulsions were all within the safe range. However, when the concentration of monovalent cations (Na +, K +) was 38.9 mmol/L, the concentration of divalent cation (Ca 2+) was 5 mmol/L, and the concentration of trace elements (Zn 2+, Cu 2+, Mn 2+, and Se 4+) was higher than 0.063 mmol/L, the PFAT5 value was higher than 0.05%. In this case, filtration with a 1.2 μm filter was necessary, which could significantly reduce the PFAT5 value and the globule size distribution, and improve the safety and standardization of the clinical application of PN solutions. It is suggested that the neonatal PN solutions supplemented with multiple trace elements injection (I) may be administered through a terminal filter.