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Oxygen and parenteral nutrition two main oxidants for extremely preterm infants: 'It all adds up'
I Mohamed1, W Elremaly2, T Rouleau1,2
1Department of Pediatrics-Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada.
Insights
Early oxygen supplementation and parenteral nutrition in extremely preterm infants are linked to increased oxidative stress and a higher risk of bronchopulmonary dysplasia (BPD). Judicious use of oxygen and optimized nutrition support are key to reducing BPD incidence.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Medicine
- Biochemistry
Background:
- Extremely preterm infants (<29 weeks gestation) are at high risk for bronchopulmonary dysplasia (BPD).
- Early respiratory support and nutritional interventions are critical for survival but may influence oxidative stress.
- Understanding the impact of oxygen and parenteral nutrition (PN) on oxidative stress is crucial for BPD prevention.
Purpose of the Study:
- To evaluate the effect of early oxygen (O2) exposure and parenteral nutrition (PN) on oxidative stress.
- To determine the association between O2 and PN with bronchopulmonary dysplasia (BPD) at 36 weeks post-menstrual age (PMA).
Main Methods:
- Prospective observational study of 116 infants <29 weeks gestation.
- Collected data on FiO2, PN duration, and clinical outcomes.
- Measured whole blood glutathione (GSH/GSSG) and calculated redox potential in 39 infants at 36 weeks PMA.
Main Results:
- Higher FiO2 (≥25%) and longer PN duration (>14 days) were associated with increased GSSG levels and a more oxidized redox potential.
- Both increased FiO2 and prolonged PN duration significantly increased the odds of developing BPD.
- Each 1% increase in FiO2 raised BPD odds by 1.57; each extra day of PN raised odds by 1.17.
Conclusions:
- Early O2 supplementation and PN have additive effects contributing to prolonged oxidative stress.
- These interventions are associated with an increased risk of BPD in extremely preterm infants.
- Strategies for judicious O2 use and optimized PN (duration, formulation) are needed to reduce BPD.
Objectives:
To assess the effect of early exposure to O2 and parenteral nutrition (PN) on oxidative stress at 36 weeks post-menstrual age (PMA) and on bronchopulmonary dysplasia (BPD) in extremely preterm infants.
Study Design:
A prospective observational study including 116 infants <29 weeks of gestation. Baseline clinical characteristics, FiO2 on day 7, duration of PN and clinical outcomes data were collected. In 39 infants, whole blood glutathione (GSH) and oxidized glutathione (GSSG) at 36 weeks PMA were measured and the redox potential was calculated using Nernst equation. Student's t-test, Chi-square, Spearman correlation, ANOVA, and logistic regression analyses were used as appropriate. P < 0.05 was considered significant.
Results:
FiO2 ≥25% was associated with higher level of GSSG (0.29 ± 0.04 versus 0.18 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-191 ± 2 versus -198 ± 2 mV) and more BPD (90% versus 45%). PN duration >14 days was also associated with higher level of GSSG (0.26 ± 0.03 versus 0.13 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-193 ± 5 versus -203 ± 2 mV) and more BPD (89% versus 24%). In logistic regression model, each 1% increase in FiO2 and each day increase in PN duration resulted in an increase in the OR for BPD by 1.57 (1.09 -2.28) and 1.17 (1.03 -1.33) respectively.
Conclusion:
Early O2 supplement and PN have additive effects that were associated with prolonged oxidative stress and increased risk of BPD. Strategies targeting judicious use of O2 and decreasing the duration or developing a safer formulation of PN can be targeted to decrease BPD.
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