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Physical compatibility of lipid emulsions and intravenous medications used in neonatal intensive care settings
  1. S M D K Ganga Senarathna1,
  2. Tobias Strunk2,3,
  3. Michael Petrovski4,
  4. Sarah Woodland4,
  5. Jorge Martinez1,
  6. Victor T G Chuang1,
  7. Kevin T Batty1,5
  1. 1Curtin Medical School, Curtin University, Perth, Western Australia, Australia
  2. 2Medical School, University of Western Australia, Crawley, Western Australia, Australia
  3. 3Neonatal Directorate, Child and Adolescent Health Service, Subiaco, Western Australia, Australia
  4. 4Pharmacy Department, Women and Newborn Health Service, Subiaco, Western Australia, Australia
  5. 5Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Professor Kevin T Batty, Curtin Medical School, Curtin University, Perth, Western Australia, Australia; kevin.batty{at}


Objective The purpose of this study was to investigate the physical compatibility of intravenous lipid emulsions with parenteral medications used in neonatal intensive care.

Methods Lipid emulsion and drug solutions were combined 1:1 in glass vials, inspected for physical incompatibility at 0, 1 and 2 hours, and assessed on the basis of lipid droplet size at 0 and 2 hours after mixing. Intravenous fluid controls (Water for Injection, sodium chloride 0.9% w/v, glucose 5% w/v), positive controls (gentamicin, albumin), negative controls (metronidazole, paracetamol, vancomycin) and 21 previously untested drug combinations were evaluated.

Results No phase separation, change in colour, gas production or other visible anomaly was observed. The between-run mean droplet diameter (MDD) for SMOFlipid20% alone (0.301±0.008 µm) was comparable to the lipid emulsion/intravenous fluid and lipid emulsion/drug solution combinations. In addition to gentamicin and albumin, caffeine citrate (20 mg/mL) was shown to be incompatible with the lipid emulsion. All other lipid:drug combinations were compatible, based on the MDD data.

Conclusion Intravenous lipid emulsions were found to be compatible with 20 parenteral medications, including antimicrobial agents, inotropes, anti-inflammatory drugs and caffeine base, in simulated Y-site conditions. The lipid emulsion was incompatible with caffeine citrate injection.

  • Administration, Intravenous
  • Drug Compounding

Data availability statement

Data are available upon reasonable request.

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