Light-exposed parenteral nutrition solutions and implications for preterm infants

Abstract

Preterm infants are more vulnerable to oxidative stress, owing to having lower levels of plasma antioxidants, plasma metal-binding proteins, and reduced activity of erythrocyte superoxide dismutase. Light exposure induces the generation of peroxides from various parenteral nutrition preparations, particularly multivitamins. Peroxides are generated in total parenteral nutrition solutions in the presence of electron donors such as ascorbic acid, amino acids, and polyunsaturated fatty acids. Peroxides result in oxidative stress, with significant damage to cell integrity. Peroxides and free radicals have been implicated in the pathogenesis of various complications associated with prematurity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity. Protection of parenteral nutrition from ambient light and phototherapy was associated with decreased peroxide load, better nutrient handling, better feeding tolerance, and lower incidence of bronchopulmonary dysplasia in preterm infants. Clinical evidence on the value of protecting parenteral nutrition solutions from light is still lacking a strong-powered randomized control trial that correlate the photoprotection with evidence of oxidative stress and short- and long-term outcomes of preterm infants.