An Animal Model for Measuring the Effect of Common NICU Procedures on ATP Metabolism

Plank, Megan S.; Boskovic, Danilo S.; Tagge, Edward P.; Chrisler, John; Slater, Laurel; Angeles, Katherine R.; Angeles, Danilyn M.

doi:10.1177/1099800411400407

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…The time period of 30 minutes after TDP for blood sample collection was based on previous investigations which showed plasma levels of MDA significantly increasing 15–30 minutes after ischemia-reperfusion 30, 44 and remaining elevated up to 2 hours later 23 . Our pilot study in rabbit kits also showed elevations of uric acid thirty minutes after a single heel lance 32 . To isolate the effects of TDP, subjects were given at least one hour of “quiet time” in which no TDPs were performed before baseline blood samples were drawn and no additional TDPs were performed during the study period.…”

Section: Methodssupporting

confidence: 54%

“…Theoretically, an increase in oxygen consumption should increase the utilization and degradation of ATP to its purine by-products, specifically uric acid (Figure 1). We made this observation in a pilot study from our laboratory where we reported increased uric acid concentration in rabbit kits subjected to a single heel lance 32 Because the process of purine degradation can result in the production of hydrogen peroxide, markers of oxidative stress can theoretically increase. This, in fact, was observed by Belliene, et.…”

Section: Introductionmentioning

confidence: 99%

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Procedural Pain and Oxidative Stress in Premature Neonates

Slater

Asmerom

Boskovic

et al. 2012

The Journal of Pain

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Preterm neonates exposed to painful NICU procedures exhibit increased pain scores and alterations in oxygenation and heart rate. It is unclear whether these physiologic responses increase the risk of oxidative stress. Using a prospective study design, we examined the relationship between a tissue-damaging procedure (TDP, tape removal during discontinuation of an indwelling central arterial or venous catheter) and oxidative stress in 80 preterm neonates. Oxidative stress was quantified by measuring uric acid (UA) and malondialdehyde (MDA) concentration in plasma before and after neonates experienced a TDP (n=38) compared to those not experiencing any TDP (control group, n=42). Pain was measured before and during the TDP using the Premature Infant Pain Profile(PIPP). We found that pain scores were higher in the TDP group compared to the control group (median scores:11 and 5, respectively, P<0.001). UA significantly decreased over time in control neonates but remained stable in TDP neonates (132.76μM to 123.23μM vs.140.50μM to 138.9μM, P=0.002). MDA levels decreased over time in control neonates but increased in TDP neonates (2.07μM to 1.81μM vs. 2.07μM to 2.21μM, P=0.01). We found significant positive correlations between PIPP scores and MDA. Our data suggest a significant relationship between procedural pain and oxidative stress in preterm neonates.

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Section: Methodssupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Procedural Pain and Oxidative Stress in Premature Neonates

Slater

Asmerom

Boskovic

et al. 2012

The Journal of Pain

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“…As a result of this metabolic switch, ATP is broken down to generate energy. 49 The degradation of ATP results in elevated levels of adenosine monophosphate and free adenosine that are catabolized into inosine monophosphate and inosine, respectively. Then, inosine and inosine monophosphate are converted into Hx, Xa, and UA.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of ATP degradation, the stress and associated morbidities experienced by preterm infants may be partially explained by an oxygen supply that cannot meet the body's demands and the switch from aerobic to anaerobic metabolism. As a result of this metabolic switch, ATP is broken down to generate energy 49. The degradation of ATP results in elevated levels of adenosine monophosphate and free adenosine that are catabolized into inosine monophosphate and inosine, respectively.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents

Forde

Fang

Miaskowski

2021

Advances in Neonatal Care

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Background: Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood. Objective: Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress. Methods: A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria. Results: Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC. Implications for Practice and Research: While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC. Video Abstract available at: https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48

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“…We previously reported that commonly performed neonatal intensive care unit (NICU) procedures, such as heel lance 1 or tape removal, 2 not only caused pain but also significantly increased markers of adenosine triphosphate (ATP) utilization and oxidative stress in premature neonates. More importantly, we also reported that oral sucrose, an intervention commonly used to relieve procedural pain, also significantly increased markers of ATP depletion and oxidative stress.…”

Section: Introductionmentioning

confidence: 99%

Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress

et al. 2015

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Objective:To examine the effects of oral sucrose on procedural pain, and on biochemical markers of adenosine triphosphate utilization and oxidative stress in preterm neonates with mild to moderate respiratory distress.Study design:Preterm neonates with a clinically required heel lance that met study criteria (n = 49) were randomized into three groups: (1) control (n = 24), (2) heel lance treated with placebo and non-nutritive sucking (n = 15) and (3) heel lance treated with sucrose and non-nutritive sucking (n = 10). Plasma markers of adenosine triphosphate degradation (hypoxanthine, xanthine and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the Premature Infant Pain Profile. Data were analyzed using repeated measures analysis of variance, chi-square and one-way analysis of variance.Results:We found that in preterm neonates who were intubated and/or were receiving ⩾30% FiO2, a single dose of oral sucrose given before a heel lance significantly increased markers of adenosine triphosphate use.Conclusion:We found that oral sucrose enhanced adenosine triphosphate use in neonates who were intubated and/or were receiving ⩾30% FiO2. Although oral sucrose decreased pain scores, our data suggest that it also increased energy use as evidenced by increased plasma markers of adenosine triphosphate utilization. These effects of sucrose, specifically the fructose component, on adenosine triphosphate metabolism warrant further investigation.

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An Animal Model for Measuring the Effect of Common NICU Procedures on ATP Metabolism

Cited by 4 publications

References 18 publications

Procedural Pain and Oxidative Stress in Premature Neonates

Procedural Pain and Oxidative Stress in Premature Neonates

A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents

Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress

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