Recent data suggest that free radical injury occurs in the neonatal brain after hypoglycemia in animal models. We developed an ELISA allowing the quantitative determination of nitrated plasma albumin (nitroalbumin, PNA) as a biomarker of peroxynitrite generation and investigated the potential nitro-oxidative stress induced by hypoglycemia (< 2.5 mmol/L) in premature newborns.
We measured PNA concentrations at days 0, 1 and 4 of life in 72 preterm infants without any other obvious cause of nitro-oxidative stress such as infection, asphyxia and hyperglycemia. Glucose levels were monitored every 3–4 hours using a strip method. For each patient, we calculated the AUCs for glycaemia measured during the 12, 18 and 24 hours preceding blood sampling as an index of the severity, the number and the duration of hypoglycemic events during the first day of life. Statistical analysis was performed using non-parametric tests.
PNA concentrations were significantly higher in hypoglycaemic than in normoglycemic infants at days 0, 1 and 4. A significant inverse correlation was found between PNA at D1 and AUGs. PNA concentration at D1 is related to the number of hypoglycemic events. Gender, term, oxygen exposure, respiratory and hemodynamic parameters were not correlated with PNA concentrations.
Thus, low glycemia levels during the first day of life are specifically associated with increased albumin nitration in preterm newborns, especially in case of recurrent hypoglycemia. This suggests the occurrence of systemic nitro-oxidative stress implying a risk of end-organ damage due to protein nitration, lipid peroxidation and DNA damage, in particular to the brain.
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