Analysis Of Hypertriglyceridemia In The Early Postnatal Period And Its Effect On Hospitalization Outcomes And The Associated Risk Factors In Very Preterm Infants

ObjectiveTo study the risk factors associated with hypertriglyceridemia in the early postnatal period and its impact on hospitalization outcomes in very preterm infants（VPIs）.MethodsIn this study,a retrospective cohort study was performed.The VPIs enrolled in this study were those who admitted to the neonatal intensive care unit from September,2019 to May,2022.The clinical data including maternal disorders,neonatal hospitalization treatment,serum triglyceride（TG）concentration in the first 4 weeks of hospitalization,and the complications were collected.They were divided into hypertriglyceridemia group（serum TG>2.8 mmol/L at any time point in the first 4weeks）and non-hypertriglyceridemia group（serum TG≤2.8 mmol/L at each time point in the first 4 weeks）,and the risk factors for hypertriglyceridemia in the early postnatal period were compared and analyzed,as well as the impact on hospitalization outcomes.Results（1）There were 497,384,341,337 and 298 VPIs received serum lipids test on the1^st,7^th,14^th,21^st and 28^th day after birth,respectively.The mean concentrations of TG were 0.34±0.33,1.84±1.72,2.90±0.92,2.90±1.12 and 0.89±0.63 mmol/L,while the occurrences of hypertriglyceridemia were 2 cases（0.4%）,57 cases（14.8%）,21 cases（6.2%）,17 cases（5.0%）and 5 cases（1.7%）,respectively.（2）There were 187 VPIs enrolled in analysis,with 78 cases in hypertriglyceridemia group and 109 cases in non-hypertriglyceridemia group.While compared with the non-hypertriglyceridemia group,the VPIs in the hypertriglyceridemia group had smaller birth gestational age,lower birth weight,shorter length and smaller head circumference at birth（P<0.05）;but had higher percentage in small for gestational age,Apgar score≤7 at 1,5 and 10 minute（s）,and maternal hypertension disorders in pregnancy（P<0.05）.（3）The hospitalization duration,expenses,corrected age at discharge,proportion of weight growth retardation at discharge,total days of parenteral nutrition,proportion of invasive ventilation,duration of invasive ventilation and total days of oxygen therapy in hypertriglyceridemia group were all greater than those in non-hypertriglyceridemia group（P<0.05）,while the proportion of the use of multi-oil fat emulsion injection in parenteral nutrition and the cumulative consumption of fat emulsions in the second week were all less than those in non-hypertriglyceridemia group（P<0.05）.（4）Multivariate logistic regression analysis showed that delayed enteral feeding was an independent risk factor for hypertriglyceridemia in VPI（OR=1.291,95%CI:1.009～1.652）,and the use of multi-oil fat emulsion injection in parenteral nutrition was a protective factor（OR=0.099,95%CI:0.035～0.280）.（5）After matching the confounding factors such as gestational age,birth weight and sex with propensity score,the incidence of moderate-severe bronchopulmonary dysplasia in hypertriglyceridemia group was higher than that in non-hypertriglyceridemia group（P<0.05）.ConclusionsThe incidence of hypertriglyceridemia in the early postnatal period was high in VPIs,and it was associated with some clinical factors,of which delayed enteral feeding was an independent risk factor and the use of multi-oil fat emulsion injection in parenteral nutrition was a protective factor.The hypertriglyceridemia increased risk for moderate to severe bronchopulmonary dysplasia in VPIs,but the impact on the medium and long term outcomes remains to further study.