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Published on: November 20, 2015
Inflammatory response in preterm infants is induced early in life by oxygen and modulated by total parenteral
Pascal M Lavoie1, Jean-Claude Lavoie, Carla Watson
1Division of Neonatology, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada.
Insights
Parenteral multivitamins (MVP) coadministered with lipid emulsion (LIP) in total parenteral nutrition (TPN) may prevent inflammation. Protecting LIP from light significantly reduced inflammatory markers in premature infants, regardless of oxygen exposure.
Area of Science:
- Neonatal nutrition and inflammation
- Oxidative stress in premature infants
- Parenteral nutrition complications
Background:
- Intravenous lipid emulsion (LIP) can be a source of oxidants, potentially triggering inflammation.
- Coadministration of parenteral multivitamins (MVP) with LIP has been shown to prevent lipid peroxidation in light-exposed total parenteral nutrition (TPN).
- The impact of TPN administration on systemic inflammation, particularly concerning oxygen exposure, requires further investigation.
Purpose of the Study:
- To investigate whether the TPN administration method influences systemic inflammation in premature infants.
- To determine if oxygen exposure modulates systemic inflammation in infants receiving different TPN regimens.
- To assess the role of light protection for lipid emulsions in mitigating inflammatory responses.
Main Methods:
- Premature infants were assigned to three TPN groups: control (MVP with light-exposed amino acids/dextrose, LIP separate), LIP+MVP light-exposed (LE), and LIP+MVP light-protected (LP).
- Plasma IL-6 and IL-8 levels, and whole blood glutathione redox potential (E) were measured.
- Data were analyzed based on oxygen exposure (FiO2 <0.25 vs. ≥0.25) using ANOVA.
Main Results:
- Cytokine levels (IL-6, IL-8) positively correlated with FiO2 and glutathione redox potential (E).
- High FiO2 increased cytokine levels in the control group.
- In the LE and LP groups, inflammatory markers remained unaffected by oxygen exposure, indicating a protective effect of MVP coadministration with LIP, especially when light-protected.
Conclusions:
- The formulation of TPN admixtures significantly impacts the systemic inflammatory response to oxidant stress.
- Protecting lipid emulsions from light during TPN administration may mitigate oxygen-induced inflammatory responses in premature infants.
- Careful consideration of TPN composition and light exposure is crucial for managing inflammation in vulnerable neonates.
Abstract:
The i.v. lipid emulsion (LIP) is a source of oxidants, which may stimulate inflammation. Coadministration of parenteral multivitamins (MVP) with LIP prevents lipid peroxidation in light-exposed total parenteral nutrition (TPN). We hypothesized that this modality of TPN administration affects systemic inflammation, which may be modulated by exposure to oxygen. Premature infants were allocated to three TPN regimens: control regimen - MVP coadministered with amino acid/dextrose exposed to ambient light, LIP provided separately (n = 9) - LIP+MVP light exposed (LE): MVP coadministered with light-exposed LIP (n = 9) - LIP+MVP light protected (LP): MVP coadministered with light-protected LIP (n = 8). In LE and LP, amino acid/dextrose was provided separately. On reaching full TPN, infants were sampled for IL-6 and IL-8 in plasma and the redox potential of glutathione in whole blood (E, mV). Data were compared (ANOVA) in infants exposed to low (<0.25) versus high (> or =0.25) FiO2. Patients (mean +/- SD: birth weight 797 +/- 172 g; GA 26 +/- 1 wk) had similar clinical characteristics in TPN groups. Cytokine levels correlated positively (p < 0.01) with FiO2 and E. High FiO2 stimulated an increase (p < 0.01) in cytokines in control regimen, whereas these markers remained unaffected by oxygen in the LE and LP groups. The choice of a TPN admixture may have important consequences on the systemic inflammatory response triggered by an oxidant stress.
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