Impact of shielding parenteral nutrition from light on routine monitoring of blood glucose and triglyceride in preterm neonates

Abstract

Background: Premature infants are vulnerable to complications related to oxidative stress. Exposure to light increases oxidation products in solutions of total parenteral nutrition (TPN) such as lipid peroxides and hydrogen peroxide. Oxidative stress impairs glucose uptake and affects lipid metabolism. Hypothesis: Products of photo-oxidation contaminating TPN affect lipid metabolism.

Objective: Evaluate the effect of photo-protection of TPN in preterm infants on plasma glucose and triglyceride concentrations (TG).

Design: Secondary analysis of a prospective study allocating preterm infants to light exposed (LE, n=32) or light protected (LP, n=27) TPN.

Setting: Level III NICU referral centre for patients of British Columbia.

Patients: Preterm infants requiring TPN.

Interventions and outcome measures: TG and blood glucose measured during routine monitoring while on full TPN were compared between LE and LP.

Results: Clinical characteristics were similar between the 2 groups (gestational age 28 ± 1 wk; birth weight:1.0 ± 0.1 kg). Nutrient intakes from TPN and from minimal enteral nutrition were comparable between LE and LP. Blood glucose was higher in preterm infants receiving LE (p<0.001). The accumulation of TG with increasing lipid intake was twice as high with LE accounting for significantly higher triglyceride levels on days 8 and 9 (p<0.05).

Conclusions: Failure to photo-protect TPN may cause alterations in intermediary metabolism. Shielding TPN from light provides a potential benefit for preterm infants by avoiding hyper triglyceridemia allowing for increased substrate delivery.