Oxygen and parenteral nutrition two main oxidants for extremely preterm infants: ‘It all adds up’

Abstract

Early O2 supplement and PN have additive effects that were associated with prolonged oxidative stress and increased risk of BPD. Strategies targeting judicious use of O2 and decreasing the duration or developing a safer formulation of PN can be targeted to decrease BPD.

Ascorbylperoxide Contaminating Parenteral Nutrition Is Associated With Bronchopulmonary Dysplasia or Death in Extremely Preterm Infants

“…H 2 O 2 constitutes >80% of these peroxides 6 . Early exposure to these oxidants has an additive effect on the oxidative stress and the development of bronchopulmonary dysplasia (BPD) 7 …”

Impact of SMOFLipid on Pulmonary Alveolar Development in Newborn Guinea Pigs

“…Results from our study comparing SMOF to IL groups that remained without photo‐protection seem to support the absence of “negative” impact of SMOF on alveolarization index. Even if hypo‐alveolarization is a characteristic of BPD, and modification of redox potential is associated with the incidence and severity of BPD, our animal model is not a premature infant with BPD. The extrapolation to humans should be done with caution, as for any animal model.…”

“…The Guinea pig has been frequently used in the last few years as a neonatal animal model of parenteral nutrition, especially for understanding the impact of PN or components of PN or oxidant molecules generated in PN on pulmonary oxidative stress deriving from free radicals or peroxides as well as on alveolarization . Several findings from this model have found a match in premature infants . In addition, its lipid metabolism is close to humans, and for this reason, it is proposed as a suitable model for lipid study …”

“…Peroxides and aldehydes generated in PN have the ability to oxidize the redox potential of glutathione in vivo. Chessex et al as well as Mohamed et al have documented a significant association between total blood oxidized redox potential and the development of BPD in premature infants.…”

“…Parenteral nutrition (PN) is essential for the survival of infants born before 30 weeks of gestation because of the immaturity of their gastro‐intestinal system. However, PN is associated with the development of bronchopulmonary dysplasia (BPD) . In newborn animals, absence of an adequate photo‐protection of PN induces a hypo‐alveolarization, the main characteristic feature of BPD, following an exaggerated apoptosis .…”