Shielding parenteral nutrition from light: does the available evidence support a randomized, controlled trial?

Area of Science:

• Neonatal research
• Clinical nutrition
• Perinatal medicine

Background:

• Ambient light exposure to total parenteral nutrition (TPN) generates peroxides, increasing oxidant stress.
• Oxidant stress may worsen complications of prematurity, such as bronchopulmonary dysplasia (BPD).
• Photoprotection of TPN reduces peroxides and has shown benefits in animal and human studies.

Purpose of the Study:

• To determine if photoprotection of TPN reduces bronchopulmonary dysplasia or death in preterm infants.
• Comparison between light-protected and light-exposed TPN.

Main Methods:

• Retrospective analysis of infants born at <28 weeks' gestation in Canadian NICUs in 2006.
• Data sourced from the Canadian Neonatal Network.
• Logistic regression models used to analyze BPD and death rates.

Main Results:

• Thirteen NICUs used partial TPN photoprotection; 13 used no photoprotection. No NICUs used complete photoprotection.
• Incidence of BPD or death was 66% with partial photoprotection (n=428) vs. 59% without (n=438).

Conclusions:

• Partial TPN photoprotection was not linked to reduced BPD or death.
• The observed relationship was confounded by other factors.
• Complete photoprotection requires further investigation via a randomized controlled trial.