Intravenous lipids should be started with the first day of full parenteral nutrition at:

• A. 1.0 gm/kg per day
• B. 2.0 gm/kg per day
• C. 3.0 gm/kg per day
• D. 4.0 gm/kg per day

Answer: (C)

Providing lipids from day one of full parenteral nutrition is essential to supply energy and prevent essential fatty acid deficiency in neonates. Lipids deliver about 9 kcal per gram, so a dose around 3 g/kg/day helps meet the high energy needs of newborns (and especially preterm infants) while delivering essential fatty acids like linoleic and linolenic acids that are crucial for growth, brain development, and skin integrity. This amount sits in the commonly targeted range for initiating lipid support in neonates, balancing the need for adequate calories with the risk of lipid intolerance or PN-associated cholestasis that can increase with very high doses. Of course, lipids should be monitored with triglyceride levels and adjusted if there are signs of intolerance or metabolic complications, but starting at 3 g/kg/day emphasizes both energy provision and prevention of EFAD from the outset. Lower starting doses may not meet energy and EFAD needs, while higher doses carry more risk and require closer monitoring.