Significance of Phototherapy-Induced Riboflavin Deficiency in the Full-Term Neonate

Amin, Harish; Shukla, Arti; Snyder, Fred H.; Fung, Ellen B.; Anderson, Norma McFarlane; Parsons, Howard G.

doi:10.1159/000243534

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…Because renal elimination of metabolites, other than free riboflavin, occurs only in minor amounts (28), the arteriovenous concentration gradient should be produced predominantly by tissue uptake and not by renal elimination. As indicated above, sufficient coenzyme saturation of FAD-dependent enzymes with their cofactors was observed in preterm as well as in full-term infants (6,19,20). This also suggests successful utilization.…”

Section: Discussionmentioning

confidence: 52%

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Intrauterine Vitamin B2 Uptake of Preterm and Full-Term Infants

Zempleni¹,

Link

Bitsch³

1995

Pediatr Res

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Intrauterine uptake of vitamin B, in preterm and full-term infants was examined. Factors of influence on vitamin supply were considered. Forty-four women and their infants were included in the study. Fetal vitamin uptake was calculated as arteriovenous concentration gradient in cord plasma times umbilical plasma flow. Concentration of vitamin B, (free riboflavin and flavocoenzymes) was determined by high performance liquid chromatography of placental tissue and blood plasma (maternal vein, umbilical artery, umbilical vein). Flavocoenzymes were analyzed as flavin mononucleotide after acid hydrolysis of flavin adenine dinucleotide. Umbilical plasma flow was measured using pulsed Doppler sonography. Both free riboflavin and flavocoenzymes were transferred from the maternal plasma to the umbilical vein, but only free riboflavin was accumulated (-1:4 for preterm and full-term infants, respectively). Flavocoenzyme concentration was higher in the umbilical vein than in the umbilical artery (p < 0.05). This indicated a median uptake of flavocoenzymes of 1.5 nmol/miwkg in preterm infants and 0.4 nmoll miwkg in full-term infants (preterm versus full-term, p < 0.01). Arteriovenous concentration differences in umbilical blood have been reported for a variety of nutrients, e.g. amino acids or glucose (1, 2). In general, concentrations of these nutrients have been found to be more elevated in plasma from the umbilical vein than the umbilical artery. Such differences suggest a fetal uptake of nutrients (Fig. 1); however, they do not allow any quantitative assessment. To be able to quantify fetal uptake, it is not only necessary to determine arteriovenous gradients, but also plasma flow in cord vessels (4). (8,9). In such instances a reduced transplacental transfer is expected to occur (10). The placenta's role is threefold: to sequester free riboflavin and flavocoenzymes, to hydrolyze the majority of the flavocoenzymes to yield free riboflavin, and to release both free riboflavin and its coenzyme forms into fetal circulation (5, 11).The build-up of a riboflavin concentration gradient was also

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Section: Discussionmentioning

confidence: 52%

“…The lower vitamin uptake observed in full-term infants seems to remain without functional consequence. Correspondingly, coenzyme saturation of FAD-dependent enzymes such as glutathione reductase or acyl-CoA dehydrogenase was described to be sufficient for preterm and full-term infants, respectively (6,19,20).…”

Section: Discussionmentioning

confidence: 99%

Intrauterine Vitamin B2 Uptake of Preterm and Full-Term Infants

Zempleni¹,

Link

Bitsch³

1995

Pediatr Res

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“…However, the peak of the action spectrum of riboflavin in neonates may be altered due to the back-scattering of light and competing photon absorption by oxyhemoglobin, desoxyhemoglobin, and melanin, as has been determined for bilirubin [10]. By the absorption of a photon, riboflavin in the skin can act as a photosensitizer and transfer energy to molecular oxygen, yielding hydrogen peroxide and oxidative products of riboflavin itself [46], thereby reducing the riboflavin level [45,47,48]. Using blue-green LED light instead of blue light, we hypothesize that the decomposition rate of riboflavin will most likely be increased.…”

Section: Riboflavin Levelmentioning

confidence: 99%

Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy—Safety Considerations

Ebbesen

Vreman

Hansen

2022

IJMS

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We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based on these results, we recommended that the phototherapy of hyperbilirubinemic newborns be practiced with light of ~480 nm. Aim: Identify and discuss the most prominent potential changes that have been observed in the health effects of phototherapy using either blue fluorescent- or blue LED light and speculate on the expected effects of changing to blue-green LED light phototherapy. Search the phototherapy literature using the terms neonate, hyperbilirubinemia, and phototherapy in the PubMed and Embase databases. Transitioning from blue fluorescent light to blue-green LED light will expose neonates to less light in the 400–450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates. The riboflavin level may decline, and the increased production and retention of bronze pigments may occur in predisposed neonates due to enhanced lumirubin formation. The production of pre-inflammatory cytokines may rise. Hemodynamic responses and transepidermal water loss are less likely to occur. The risk of hyperthermia may decrease with the use of blue-green LED light and the risk of hypothermia may increase. Parent–neonate attachment and breastfeeding will be positively affected because of the shortened duration of phototherapy. The latter may also lead to a significant reduction in the cost of phototherapy procedures as well as the hospitalization process.

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Reuniting overnutrition and undernutrition, macronutrients, and micronutrients

Kim

Basharat

Ramakrishnan

et al. 2018

Diabetes Metabolism Res

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Over-nutrition and its late consequences are a dominant theme in medicine today. In addition to the health hazards brought on by over-nutrition, the medical community has recently accumulated a roster of health benefits with obesity, grouped under "obesity paradox." Throughout the world and throughout history until the 20 century, under-nutrition was a dominant evolutionary force. Under-nutrition brings with it a mix of benefits and detriments that are opposite to and continuous with those of over-nutrition. This continuum yields J-shaped or U-shaped curves relating body mass index to mortality. The overweight have an elevated risk of dying in middle age of degenerative diseases while the underweight are at increased risk of premature death from infectious conditions. Micronutrient deficiencies, major concerns of nutritional science in the 20 century, are being neglected. This "hidden hunger" is now surprisingly prevalent in all weight groups, even among the overweight. Because micronutrient replacement is safe, inexpensive, and predictably effective, it is now an exceptionally attractive target for therapy across the spectrum of weight and age. Nutrition-related conditions worthy of special attention from caregivers include excess vitamin A, excess vitamin D, and deficiency of magnesium.

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Significance of Phototherapy-Induced Riboflavin Deficiency in the Full-Term Neonate

Cited by 8 publications

References 12 publications

Intrauterine Vitamin B2 Uptake of Preterm and Full-Term Infants

Intrauterine Vitamin B2 Uptake of Preterm and Full-Term Infants

Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy—Safety Considerations

Reuniting overnutrition and undernutrition, macronutrients, and micronutrients

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