TPN as a source of oxidants

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The fetus exists in a very low oxygen concentration environment and room air may be a significant oxidant stress for the preterm infant. There are also other oxidant sources that could further stress the preterm infant and contribute to a number of diseases such as retinopathy of prematurity and bronchopulmonary dysplasia (BPD). One source of oxidant product is parental alimentation that may contain lipid peroxidation and vitamin degradation products. Exposure to light can increase oxidation products in hyperalimentation solutions. Although shielding of hyperalimentation solutions from light is frequently discussed, effective shielding of the bag of hyperalimentation solution and the tubing to the site of infusion rarely occurs. Chessex et al report in a single center pilot randomized control trial that shielding of the hyperalimentation solution qualitatively decreased BPD in an underpowered study. This outcome is biologically plausible but needs to be tested in a multicenter trial. Although BPD is associated with increased oxygen exposure and decreased oxygen saturation targets can decrease the severity of BPD, treatments of infants with a number of antioxidants have not been effective. As a cautionary note, impressive outcomes from single center trials in neonatology often cannot be reproduced in larger multicenter trials. Hopefully, this simple and cheap intervention actually will work.