Parenteral Nutrition and Oxidant Load in Neonates

Abstract

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

Optimal Nutrition Parameters for Neonates and Infants with Congenital Heart Disease

“…Parenteral nutrition in newborns and infants can prove to be a major source of oxidants [50]; several studies have suggested that higher arginine and cysteine intake, along with decreased iron and copper concentrations, might help decrease the oxidant load. The range of products used for parenteral nutrition must be strictly controlled in terms of storage conditions and period, exposure to the sun and oxygen, and the temperature of administration.…”

Dexamethasone may affect the occurrence of parenteral nutrition-associated cholestasis in preterm neonates

“…Numerous risk factors for PNAC have led to various hypotheses to explain its pathogenesis. It is now believed that biologically active factors absorbed from the injured and hyperpermeable intestine, combined with components of PN solutions ( 19 ), synergize to cause hepatic inflammation, cholestasis, and subsequent fibrosis ( 7 ). Clinicopathological features of PNAC include cholestasis, variable portal vein inflammation, steatosis, and, ultimately, fibrosis and cirrhosis ( 20 ).…”

Parenteral Nutrition Overview

“…However, this recommendation should also be extended to PN for adults, since components used for adults are also susceptible to photo-oxidation. Moreover, the use of multilayered bags is also recommended to prevent oxidation [ 37 , 39 , 43 ].…”

“…With regard to the stability of the admixture, some nutrients have a destabilizing effect in the presence of other nutrients. Similarly, there are general factors affecting PN admixture stability [ 6 , 35 , 37 , 38 , 39 , 43 , 45 , 55 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]: Temperature: For example, with increased temperature, there is a raised likelihood of calcium-phosphate precipitate formation and of the degradation of several amino acids. pH: The optimal pH for IVFE stability is in the range of 6–9, whereas calcium phosphate solubility is better at lower pH values.…”