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Complete shielding of multivitamins to reduce toxic peroxides in the parenteral nutrition (C-SMART-PN): A randomized
Nadine El Raichani1, Maxime Thibaut2, Jean-Claude Lavoie1
1Department of Nutrition, Centre Hospitalier Universitaire Sainte-Justine Research Center, Université de Montréal, Montréal, Québec, Canada.
Insights
A new photoprotection method significantly reduces harmful peroxides in parenteral nutrition (PN) for preterm infants. This approach improves PN integrity and lowers infant urinary peroxide levels, potentially preventing bronchopulmonary dysplasia.
Area of Science:
- Neonatal Medicine
- Parenteral Nutrition
- Oxidative Stress
Background:
- Parenteral nutrition (PN) exposed to light increases peroxide contamination, raising oxidative stress in preterm infants and contributing to bronchopulmonary dysplasia.
- The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends PN photoprotection but notes implementation challenges.
- This study addresses the need for effective PN photoprotection strategies in neonatal intensive care.
Purpose of the Study:
- To evaluate a novel photoprotection procedure for parenteral nutrition (PN) in preterm infants.
- To assess the procedure's effectiveness in reducing peroxide load and ascorbic acid degradation in PN.
- To determine the feasibility and efficacy of the procedure in lowering urinary peroxide levels in infants.
Main Methods:
- In vitro: Neonatal PN admixtures (without lipid emulsion) were prepared and infused using standard methods or the novel photoprotection procedure (shielding multivitamins).
- In vivo: A randomized controlled pilot study involving extremely preterm infants receiving PN via standard or photoprotected methods.
- Evaluated peroxide generation, ascorbic acid degradation (in vitro), and urinary peroxide levels (in vivo).
Main Results:
- In vitro: Photoprotection decreased peroxide generation by 44% and halved ascorbic acid degradation (P < 0.001).
- In vivo: The photoprotection procedure significantly reduced urinary peroxide levels in preterm infants during the first week of life (P < 0.05).
- The study included 28 extremely preterm infants, with no significant baseline differences in urinary peroxide levels.
Conclusions:
- The novel photoprotection procedure is feasible and effective in minimizing PN peroxide contamination and preserving PN integrity.
- This method represents a promising advancement toward establishing complete PN photoprotection as a standard of care for preterm infants.
- Reducing PN-derived oxidative stress is crucial for improving outcomes in vulnerable preterm populations.
Background:
When exposed to ambient light, parenteral nutrition (PN) contamination with peroxides almost doubles, which increases oxidative stress in preterm infants, contributing to the development of bronchopulmonary dysplasia. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends complete PN photoprotection to reduce peroxide contamination and optimize its integrity but acknowledges the challenges of its implementation. In this study, a novel photoprotection procedure was tested for its effectiveness in reducing peroxide load and limiting ascorbic acid degradation, and for its feasibility and effectiveness in reducing urinary peroxide levels in preterm infants.
Methods:
In vitro evaluation included neonatal lipid injectable emulsion-free PN admixtures prepared and infused according to current practice or the suggested photoprotection procedure through separation and complete shielding of intravenous multivitamin preparation from compounding to administration through photoprotected infusion sets. In vivo evaluation included a single-center randomized controlled pilot study of extremely preterm infants receiving PN according to current practice or the suggested photoprotection procedure.
Results:
In vitro, photoprotection allowed a 44% decrease in peroxide generation (P < 0.001) and reduced by half ascorbic acid degradation in PN admixtures (P < 0.001). In vivo, 28 infants completed the study. Baseline urinary peroxide levels were similar in both groups before PN initiation, and the suggested photoprotection procedure resulted in a significant decrease in urinary peroxide levels over the first week of life (P < 0.05).
Conclusion:
The suggested procedure appears feasible and effective in reducing peroxide contamination and optimizing PN integrity, representing a step toward integrating complete photoprotection of PN as the standard of care in preterm infants.
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