Limiting light‐induced lipid peroxidation and vitamin loss in infant parenteral nutrition by adding multivitamin preparations to Intralipid

Abstract

Parenteral lipids are susceptible to light‐induced peroxidation, particularly under phototherapy. Ascorbic acid is protective. The aim of this study was to investigate whether dark delivery tubing and/or coadministration of multivitamin preparations could prevent peroxidation of Intralipid without undue vitamin loss. In experiments carried out on the benchtop, lipid peroxidation occurred in ambient light and was more extensive under phototherapy. Dark tubing decreased peroxide formation, but only by about 65%. In simulated clinical conditions in which solutions were pumped through standard clear or dark minibore plastic tubing, Intralipid accumulated lipid peroxides as measured by the FOX assay (280 μM) or as triglyceride hydroperoxides (52 μM). Multivitamin preparations (MVIP or Soluvit/Vitlipid) inhibited peroxide formation almost completely, and were fully protective when used with dark tubing. There was loss of riboflavin (65% from Soluvit and 35% from MVIP) in clear tubing but this was decreased to 18% and 11%, respectively, in dark tubing. Ascorbate loss was 20% (MVIP) and 50% (Soluvit) and only slightly less in dark tubing. Ascorbate loss was also seen in the absence of Intralipid and is due to riboflavin‐induced photo‐oxidation. Conclusion: Multivitamin preparations protect Intralipid against light‐induced formation of lipid hydroperoxides, and administering multivitamins with Intralipid via dark delivery tubing provides a practical way of preventing peroxidation of the lipid while limiting vitamin loss. This procedure should be considered for routine use as well as with phototherapy.

Neonatal Exposure to Oxidants Induces Later in Life a Metabolic Response Associated to a Phenotype of Energy Deficiency in an Animal Model of Total Parenteral Nutrition

“…H 2 O 2 may induce programming of lipid and glucose metabolism. Indeed, other peroxides derived from lipids (47) or ascorbic acid (48) and differences in food intake may also be important confounding variables. Beyond a lack of mechanistic explanation, the study documents an effect of neonatal exposure to H 2 O 2 on metabolic programming.…”

Inflammatory Response in Preterm Infants Is Induced Early in Life by Oxygen and Modulated by Total Parenteral Nutrition

“…The generation of these products of oxidation can be decreased by protection from light (23). It has been recently shown in vitro that multivitamin coadministration with the lipid moiety of TPN prevents lipid peroxidation and antioxidant vitamin loss in the infusate (21). Based on the previously documented antioxidant effect of light protection and coadministration of multivitamins with lipids, which limits the principal sources of peroxides in infants receiving TPN, we hypothesized that coadministration of i.v.…”

“…nutritional support (TPN) until optimal gut maturity is achieved to allow full enteral feeding. Light exposure of TPN induces the loss of antioxidant vitamins (21) and the generation of oxidant products of photooxidation such as hydrogen peroxide (22), lipid peroxides (23), aldehydes (24), and ascorbylperoxide (25). The generation of these products of oxidation can be decreased by protection from light (23).…”

Ascorbylperoxide Contaminating Parenteral Nutrition Perturbs the Lipid Metabolism in Newborn Guinea Pig

“…However, as administered, without adequate photoprotection, some nutritive elements are lost, and undesirable new molecules are generated. Indeed, exposure to ambient light induces a loss of antioxidant vitamins (Silvers et al, 2001) and generates nutrient oxidation byproducts such as peroxides (Helbock et al, 1993;Lavoie et al, 1997Lavoie et al, , 2000Lavoie et al, , 2004Neuzil et al, 1995;Knafo et al, 2005). Paradoxically, the main source of peroxides is the multivitamins' moiety of parenteral nutritive solution (Lavoie et al, 1997).…”