![]() ![]() Foetal heart rate monitoring was non-reassuring, with reduced variability and decelerations. The examination found arterial hypertension (145/95 mmHg) with no other sign of preeclampsia. The mother consulted at her local hospital, a type 2 perinatal centre, for headaches that had worsened over 48 h. Elevated maternal serum biochemical markers in the first trimester of pregnancy prompted a prenatal noninvasive test for trisomy 21, which was negative. The mother was overweight before pregnancy, with a BMI of 30. This boy, born at 30 + 1 weeks of gestation to a 32-year-old mother, was the first child of non-consanguineous Caucasian parents. We report an exceptionally serious adverse event following the administration of a composite intravenous lipid emulsion (ILE) and discuss the mechanism of the medication error and the pathogenesis and management of lipid overdoses in neonates. Recovery after exchange transfusion (ET) has been described in rare case reports, but it remains a high-risk procedure in sick preterm infants. ![]() Treatment of lipid overdose in newborns is not standardized. Accidental lipid overdose due to an excessive infusion rate of ILE may result in serious complications, such as respiratory failure, metabolic acidosis and even death. Intravenous lipid emulsion (ILE) infusion is also a high-risk medication, notably if lipid emulsion is infused separately from the other components of parenteral nutrition (PN). The most dangerous drugs include insulin, cardiovascular drugs, sedatives, and electrolytes. Among neonates hospitalized in NICUs, the patients most at risk are those with the lowest gestational age and birthweight, the greatest severity of illness on admission, and a prolonged length of stay. An estimated 1–8% of these iatrogenic events is life-threatening, most often resulting from errors in prescribing or programming the flow rates of electric infusion pumps by tenfold or more. Medication error is one of the leading causes of safety incidents in neonatal intensive care units (NICUs). Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. The infant’s condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. ![]() Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). Twenty-four hours after birth, a 30 weeks’ gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. ![]()
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