Intrapulmonary Lipid Deposits in Children Treated or Not with Parenteral Nutrition
DOI:
https://doi.org/10.3823/2133Keywords:
pulmonary lipid, parenteral nutrition, childrenAbstract
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 lipÃdicas parenterais e os sistemas fagocÃticos. 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.
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
Â
Â