Article Text

  1. P Chessex1,
  2. G Kaczala1,
  3. J Friel2,
  4. T Rouleau3,
  5. J C Lavoie3
  1. 1Department of Pediatrics and Neonatology, Women’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada,
  2. 2Department of Human Nutritional Sciences, Faculty of Human Ecology, University of Manitoba, Winnipeg, Manitoba, Canada,
  3. 3Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada


Objective: The co-administration of parenteral multivitamins (MVP) with lipid emulsion (LIP) is recommend to prevent lipid peroxidation and enhance antioxidant vitamin bioavailability. The biological effects of this modality have not been studied in neonates. The aim was to test the hypothesis that this total parenteral nutrition (TPN) modality offers a better protection against oxidant stress.

Methods: Three groups of preterm infants were randomly assigned to receive: C  =  amino acids (AA) + MVP exposed to light: MVP + AA, lipids provided separately (n  =  10); LE  =  LIP + MVP exposed to light: MVP administered with lipids, amino acids provided separately (n  =  10); LP  =  LIP + MVP protected from light (n  =  10). Blood was sampled on day 7 to measure the redox ratio of glutathione GSSG/(GSSG + GSH) and plasma levels (μM/l) of vitamins A and E. Data (mean ± SEM) were compared by analysis of variance for babies on low (⩽0.25) versus high (>0.25) FiO2.

Results: Clinical characteristics and nutrient intakes were similar between groups. In infants receiving C, the redox ratio was more oxidised (p<0.05) in high FiO2 (7.5 ± 1.2, n  =  5 vs 4.0 ± 0.07, n  =  5). In infants receiving LE the redox ratio remained unchanged (4.7 ± 0.5, n  =  4 vs 4.5 ± 1.1, n  =  6). There was no effect of TPN or FiO2 on vitamins A (0.56 ± 0.05) and E (33 ± 2). Shielding TPN from light did not influence redox ratio or vitamin levels.

Conclusions: LE protects against the oxidant stress associated with O2 supplementation. This is not explained by the availability of antioxidant vitamins A and E. These data support a trial to evaluate in premature infants the impact of TPN modality on long-term outcomes.

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