Intrapulmonary Lipid Deposits in Children Treated or Not with Parenteral Nutrition

Authors

  • Valmin Ramos-Silva
  • Jane S. Castello
  • Luciene L. da Motta
  • Janine Pereira da Silva
  • Gustavo Carreiro Pinasco
  • Sophia Cornbluth Szarfarc
  • Patrícia Casagrande Dias de Almeida
  • Júlia Viana Espinosa de Oliveira
  • José Mauricio de Oliveira Massena
  • Jose Paulo Ferreira Junior
  • Katia Valeria Manhambusque
  • Italla Maria Pinheiro Bezerra
  • Joel Alves Lamounier

DOI:

https://doi.org/10.3823/2133

Keywords:

pulmonary lipid, parenteral nutrition, children

Abstract

Background . Reports on pulmonary lipid deposition  after parenteral nutrition (PN) in children were based on small samples. Here we report the prevalence of pulmonary lipid deposition in 114 consecutive autopsied children from a pediatric intensive care unit, including neonates, lactants, preschool, school children and adolescents that used or not PN before death. Methods. All 114 autopsied children (January 1998 through December 2001) from the Intensive Care Unit of the Childrens’s Hospital in Vitoria, ES, Brazil (50 that received PN before death and 64 that did not receive PN). Pulmonary lipid deposit was investigated in frozen sections of two fragments of each lung (peripheral and near the hylus) stained by Oil Red O.  Results. Intrapulmonary lipid deposition was observed in 47% (54/114) of children. PN increased significantly the frequency of pulmonary lipid : 70%(35/50) in the group treated with PN and 29,6% (19/64) in the non-treated group (p=0,000). This difference persists significant if we consider separately the neonates and the children 29 days up to 15 years old (13/22 (59,1%) and 22/28(78,6%) respectively in neonates and in non neonates). Conclusion. Results demonstrated: (a) pulmonary lipid deposits are frequent in children dead at Intensive Care Unit; (b) in the group not treated with PN the frequency of lipid deposits was significantly higher in children older than 28 days than in neonates; (c) parenteral nutrition increased significantly  the risk for pulmonary lipid deposition both in neonates and children older than 28 days.

Key words : pulmonary lipid, parenteral nutrition, children

References

Waitzberg DL, Lotierzo PH, Logullo AF, Torrinhas RSMM, Pereira CCA. Emulsões lipídicas parenterais e os sistemas fagocíticos. Nutrição em pauta 2002;21-29.

LeVeen HH, Giordano P, Spletzer J. The mechanism of removal of intravenously injected fat. Arch Surg 1961;83:311-21.

Barson AJ, Chiswick ML, Doig CM. Fat embolism in infancy after intravenous fat infusions. Arch Dis Child 1978;53:218-23.

Dahms BB, Halpin TC. Pulmonary arterial lipid deposit in newborn infants receiving intravenous lipid infusion. J Pediatr 1980;97:800-05.

Hulman G, Levene MI. Intralipid microemboli. Arch Dis Child 1986;61:702-03.

Friedman Z, Marks KH, Maisels MJ, Thorson R Naeye R. Effect of parenteral fat emulsion on the pulmonary and reticuloendothelial systems in the newborn infant. Pediatrics 1978; 61:694-98.

Hertel J, Tygstrup I, Andersen GE. Intravascular fat accumulation after Intralipid infusion in the low-birth-weight infant. J Pediatr 1982;100:975-76.

Levene MI, Wigglesworth JS, Desai R. Pulmonary fat accumulation after intralipid infusion in the preterm infant. Lancet 1980;18:815-19.

Levene MI, Batisti O, Wigglesworth JS, Desai R, Meek JH, Bulusu S, Hughes E. A prospective study of intrapulmonary fat accumulation in the newborn lung following intralipid infusion. Acta Paediatr Scand 1984;73:454-60.

Schröder H, Paust H, Schmidt R. Pulmonary fat embolism after intralipid therapy – a post-mortem artefact?. Acta Paediatr Scand 1984;73:461-64.

Puntis JW, Rushton DI. Pulmonary intravascular lipid in neonatal necropsy specimens. Arch Dis Child 1991;66:26-28.

Shulman RJ, Langston C, Schanler RJ. Pulmonary vascular lipid deposition after administration of intravenous fat to infants. Pediatrics 1987;79:99-102.

Harman JW, Ragaz FJ. The pathogenesis of experimental fat embolismo. Am J Path 1950;26:551-63.

Nordstran K, Eide TJ, Giercksky KE. Parenteral nutrition via the portal vein in rats. Acta Chir Scand 1987;153:93-98.

Aksnes J, Eide TJ, Nordstrand K. Pulmonary intravascular macrophages appear in rats after long-term administration of lipid emulsion and amino acid solution. APMIS 1998;106:687-92.

Aksnes TA, Foerster A, Hovig T, Schmidith H, Nordstran K. Development of granulomas and vascular fibrocelular proliferations in the lungs of pigs receiving long-term lipid-based parenteral nutrition. APMIS 1994;102:623-32.

Hulman G. The patogenesis of the embolism. J Pathol 1995;176:3-9.

Allardyce DB. The postmortem interval as a factor in fat embolism. Arch Path 1971; 92:248-53.

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Published

2016-10-24

Issue

Section

Pediatrics

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