Pharmaceutical and clinical aspects of parenteral lipid emulsions in neonatology

SummaryThe use of lipid emulsions in the care of pre-term and term infants in the intensive care unit setting is essential in the absence of enteral intake. We review the use of lipid emulsions of varying oil composition that might be considered for use in this population in terms of their pharmaceutical characteristics, including their compliance with the newly adopted globule size limits from the United States Pharmacopeia. These limits are intended to establish pharmaceutical equivalence amongst manufacturers with respect to the quality of the emulsion. In addition, the implication of exceeding these limits in terms of infusion safety in neonates is also presented. This review also summarizes important clinical issues for consideration regarding the composition and dosing of various oil mixtures, as well as potential benefits of using lipid emulsions with reduced amounts of the pro-inflammatory ω-6 fatty acids.