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Delivery of vitamin A from parenteral nutrition solutions in neonates
D G Thomas1, S L James, A Fudge
1Department of Paediatrics, Flinders Medical Centre, Bedford Park, South Australia.
Insights
Parenteral nutrition often delivers insufficient Vitamin A. Mixing multivitamins in lipid solutions significantly improves Vitamin A delivery, crucial for preventing deficiency in preterm infants.
Area of Science:
- Nutritional Science
- Clinical Pharmacy
- Pediatric Medicine
Background:
- Parenteral nutrition (PN) is vital for patients unable to consume food orally.
- Suboptimal delivery of essential micronutrients like Vitamin A from PN can lead to deficiencies.
- Preterm infants are particularly vulnerable to Vitamin A deficiency due to their increased nutritional demands.
Purpose of the Study:
- To investigate the stability and delivery efficiency of Vitamin A from parenteral nutrition solutions.
- To evaluate the impact of different admixture formulations on Vitamin A delivery.
- To identify optimal methods for ensuring adequate Vitamin A provision in PN.
Main Methods:
- Preparation of PN solutions with varying vitamin formulations.
- Quantification of Vitamin A and E concentrations in solution bags and infusion lines over 24 hours.
- Assessment of delivery efficiency under different conditions, including light protection and varying container materials.
Main Results:
- Vitamin A levels significantly declined in standard PN solutions, with only 10% delivered.
- Light protection and ethylene vinyl acetate systems did not improve Vitamin A delivery.
- Mixing vitamins in lipid emulsions reduced loss, but delivery was variable (70% expected).
- Adding vitamins to a lipid-dextrose-amino acid solution resulted in high Vitamin A delivery (94% expected).
- Vitamin E delivery was consistent across systems, averaging 74%.
Conclusions:
- Standard PN admixtures lead to poor Vitamin A delivery, increasing deficiency risk.
- Incorporating vitamins into lipid-dextrose-amino acid solutions optimizes Vitamin A delivery.
- This finding is critical for improving nutritional support and outcomes in vulnerable populations like preterm infants.
Abstract:
The delivery of Vitamin A from parenteral nutrition may be suboptimal. To investigate this sample solutions were prepared and Vitamins A and E concentrations from the solution bags and the efflux from the lines were measured over a 24 h period. The results show that mean Vitamin A levels in the solution bags declined from a range of 57-66% to 17% of expected over 24 h and at the efflux of the lines from a range of 13-29% to 4% of expected, giving a calculated delivery of 10% of expected. There is no improvement with light protection or an ethylene vinyl acetate system. Mixing the vitamin preparation in lipid showed less decline (from 92 to 70% of expected over 24 h), but the delivery was variable. When vitamins were added to a lipid-dextrose-amino acid solution, there was minimal loss from the solution bag and line with a calculated delivery of 94% of expected. The delivery of Vitamin E from all systems was constant with a mean calculated delivery of 74% of expected. It was concluded that the mixing of multivitamins in dextrose-amino acid-electrolyte solutions results in poor delivery of Vitamin A and this is improved by mixing lipid solution. This is important in preterm infants who are prone to become Vitamin A deficient.