Antioxidant Supplementation Reduces In Vitro Oxidant Generation in Neonatal Total Parenteral Nutrition Solutions

Newborns with gastrointestinal anomalies or premature birth often require lifesaving nutritional support in the form of total parenteral nutrition (TPN). However, TPN administration causes several complications in newborns. Several studies have suggested that it could be due to oxidant generation in the TPN admixture because of various factors.

This study aimed to reduce the peroxidation of the commercially available TPN for newborns by increasing concentrations of antioxidants, decreasing concentrations of prooxidants, and optimizing environmental conditions, leading to the development of a new admixture with lower oxidant load.

Standard all-in-one (AIO)-TPN was used as a control diet and various antioxidants or prooxidants were supplemented above standard concentrations to determine effects on peroxide concentrations. TPNs were also exposed to light to determine environmental effects on oxidant load.

Peroxide concentrations in the AIO-TPN significantly increased with higher light intensity. Compared with standard AIO-TPN, AIO-TPN with a combination of L-ascorbic acid (at 2.27 mM), DL-α-tocopherol acetate (at 124.1 μM), glutathione (at 40 μM), copper (at 4.2 μM), and zinc (at 30.6 μM) in the AIO-TPN had significantly lower peroxide concentrations. The increasing combinations of vitamins C and E showed an additive effect on lowering the peroxide concentrations, whereas various combinations of copper and zinc alone did not change peroxide concentrations.

Peroxide concentrations were significantly increased when TPN was exposed to light, but optimization using a specific combination of antioxidants significantly reduced the degree of peroxidation. Overall, this study gives novel insight into a promising strategy to develop a new TPN formula for newborns, particularly preterm infants, to decrease in vitro oxidant load.