Total Parenteral Nutrition and Oxidant Load in Neonates

Total Parenteral Nutrition and Oxidant Load in Neonates 

Kandeepan Karthigesu
PhD Student
Department of Biochemistry Memorial University

Monday, March 14, 2022
Time: 1-2 pm
Location: Arts Building Room 1046 (IN PERSON)

Abstract:

Total Parenteral Nutrition and Oxidant Load in Neonates

Neonates who are intolerant to oral feeding due to preterm birth (£36 weeks), very low birth weight (<1500 g), or gastrointestinal disorders, typically require total parenteral nutrition (TPN) for survival. However, TPN can generate oxidants in vitro due to interactions between elemental nutrients, imbalances of anti- and pro-oxidants, and exposure to light and oxygen. Hence, TPN is a key source of harmful oxidant exposure to such neonates. Immature antioxidant systems of neonates also fail to overcome these overwhelming oxidants. Several studies have shown that prolonged feeding of oxidant overloaded TPN causes several complications, including liver diseases, bronchopulmonary dysplasia, gut atrophy, necrotizing enterocolitis, and retinopathy. Recent studies have suggested that ingredient manipulation or different composition of lipid emulsions with vitamin E can lower the oxidants in TPN. However, the systematic approach by increasing the levels of antioxidant vitamins, reducing pro-oxidants, and protecting from light and oxygen has still not been examined. Hence, we hypothesize that supplementation with additional antioxidants, including vitamins and glutathione; additional arginine and additional cysteine; reduced levels of iron and zinc; protection from light and oxygen; and appropriate storage temperature would lower oxidant load in the TPN solution. Herein, rapid in vitro model systems, including a THP-1 human monocyte cell model and LC-MS/MS, are employed to assess the oxidants in TPN solutions before infusing. The oxidant minimized TPN will then be examined using a piglet model to assess in vivo oxidative stress markers. In THP-1 human monocyte cell model, the peroxidation of the commercially available lipid emulsion SMOFlipid^Ò and the all-in-one admixture (AIO) was observed. Some oxidized fatty acids were found using LC-MS/MS. Further studies are needed to examine the role of antioxidants and pro-oxidants to mitigate the peroxide levels produced in the TPN.