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Published on: November 20, 2015
Determinants of oxidant stress in extremely low birth weight premature infants
Philippe Chessex1, Carla Watson, Gregor W Kaczala
1Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada V6H 3V4. pchessex@hotmail.com
Insights
Parenteral multivitamins (MVP) added to lipid emulsions (LIP) in total parenteral nutrition (TPN) reduce oxidant stress in premature neonates. This approach is more effective than adding MVP to amino acid solutions, especially during oxygen supplementation.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Oxidative Stress Research
Background:
- Premature neonates face significant oxidant stress.
- Total parenteral nutrition (TPN) can be a source of oxidation products.
- Lipid emulsions (LIP) with parenteral multivitamins (MVP) mitigate lipid peroxidation.
Purpose of the Study:
- To compare oxidant stress markers in premature neonates receiving different TPN formulations.
- To evaluate the impact of LIP+MVP versus amino acid solution (AA+MVP) on oxidant load.
- To assess the role of photoprotection and oxygen supplementation in TPN-induced oxidant stress.
Main Methods:
- Measured antioxidant vitamins, glutathione redox potential, isoprostane, and dityrosine.
- Sampled blood and urine from neonates on days 7 and 10.
- Compared infants requiring low vs. high fractional inspired oxygen (FiO2).
Main Results:
- Oxygen supplementation increased oxidant stress with AA+MVP but not with LIP+MVP.
- LIP+MVP demonstrated a protective effect against O2-induced oxidant stress.
- Photoprotection offered no additional benefit; blood transfusions increased oxidant load.
Conclusions:
- Administering MVP within the lipid component of TPN protects against oxygen-related oxidant stress in neonates.
- Oxidized redox potential is linked to bronchopulmonary dysplasia.
- LIP+MVP is a superior strategy for managing oxidant stress in TPN-dependent neonates.
Abstract:
Early in life, premature neonates are at risk of oxidant stress. They often require total parenteral nutrition (TPN), which is, however, contaminated with oxidation products. Coadministration of parenteral multivitamins (MVP) with a lipid emulsion (LIP) prevents lipid peroxidation. We hypothesized that LIP+MVP induces a lower oxidant load compared to preparations in which MVP is administered with an amino acid solution (AA+MVP). The aim of this study was to compare markers of oxidant stress in premature neonates receiving LIP+MVP, either exposed to or protected from light, or AA+MVP. Antioxidant vitamins, the redox potential of glutathione, isoprostane, and dityrosine were measured in urine or blood sampled on days 7 and 10 from babies requiring low (<0.25) vs high (≥0.25) fractional inspired O(2). Oxygen supplementation induced a more oxidized redox potential and increased dityrosine with AA+MVP only. Adding MVP in the lipid rather than the amino acid moiety of TPN protects against the oxidant stress associated with O(2) supplementation. Photoprotection added no benefit. Blood transfusions were found to produce a pronounced oxidant load masking the beneficial effect of LIP+MVP. The impact of these findings relates to a strong association between a more oxidized redox potential and later bronchopulmonary dysplasia, a clinical marker of oxidant stress.
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