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Published on: September 20, 2019
A randomized controlled trial on parenteral nutrition, oxidative stress, and chronic lung diseases in preterm infants
Mohamed R Bassiouny1, Hala Almarsafawy, Hesham Abdel-Hady
1Neonatal Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.
Insights
Trace elements in total parenteral nutrition (TPN) do not increase peroxides. Protecting TPN from light and adding multivitamins (MVP) significantly reduces peroxides and chronic lung disease in preterm infants.
Area of Science:
- Neonatal nutrition
- Parenteral nutrition
- Oxidative stress
Background:
- Total parenteral nutrition (TPN) is crucial for preterm infants but can be a source of oxidative stress.
- Peroxides in TPN solutions may contribute to adverse clinical outcomes.
- The role of trace elements (TEs) and light exposure in TPN-induced peroxide generation is not fully understood.
Purpose of the Study:
- To assess the impact of trace elements (TEs) in TPN on peroxide levels.
- To investigate if protecting TPN from light reduces peroxide load.
- To determine the association between light protection, peroxide levels, and clinical outcomes in preterm infants.
Main Methods:
- 80 preterm infants were randomized into four TPN groups, with subgroups protected from or exposed to light.
- Urinary peroxides were measured using the ferrous oxidation of xylenol orange technique before and after TPN initiation.
- Clinical outcomes including chronic lung disease, mortality, necrotizing enterocolitis, and sepsis were assessed.
Main Results:
- Trace elements did not influence peroxide production in TPN solutions.
- Addition of multivitamins (MVP) and exposure to light were significantly associated with increased urinary peroxides.
- Light exposure was linked to a higher incidence of chronic lung disease (adjusted OR 9.26, P=0.03) but not other morbidities.
Conclusions:
- Trace elements in TPN do not contribute to peroxide formation.
- Multivitamins and light exposure are primary sources of peroxides in TPN solutions.
- Protecting TPN from light is associated with a reduction in chronic lung disease in preterm neonates.
Objectives:
To evaluate the effect of trace elements (TEs), when added to total parenteral nutrition (TPN) solutions, on peroxides load, and to test the hypothesis that protection of TPN from light can decrease peroxides load and is associated with improvement in oxidant-related clinical outcomes in preterm infants.
Subjects And Methods:
A total of 80 preterm infants were randomized to 1 of 4 groups (n=20 each): group 1 received a mixture of dextrose and amino acids; group 2 received a mixture of dextrose, amino acids, and lipid emulsion; group 3 received dextrose, amino acids, lipid emulsion, and multivitamins (MVP); and group 4 received dextrose, amino acids, lipid emulsion, MVP, and TEs. Each group was subdivided into photo-protected and photo-exposed subgroups (n=10 each). Using ferrous oxidation of xylenol orange technique, we measured the baseline level of excreted urinary peroxides before and 48 hours after starting TPN. We examined the association among light protection, urinary peroxides, and clinical outcomes of these infants.
Results:
Baseline urinary peroxides ranged between 5.5 and 24.8 micromol/L. A significant increase in urinary peroxides was observed in all groups after receiving TPN. The use of TEs did not affect peroxide production. In regression analysis, the addition of MVP (P<0.0001) and the exposure to light (P=0.02) were significantly associated with increased urinary peroxides. In the overall population, light exposure was associated with a significant increase in the incidence of chronic lung disease (adjusted OR 9.26, confidence interval 1.2-73; P=0.03) but had no effect on mortality, necrotizing enterocolitis, or sepsis.
Conclusions:
TEs in TPN solutions have no effect on the production of urinary peroxides. Addition of MVP and exposure of TPN to light are the 2 major sources of peroxides in TPN. Protection from ambient light is associated with a decrease in chronic lung disease.
