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Influence of Shielding TPN From Photooxidation on the Number of Early Blood Transfusions in ELBW Premature Neonates

Stritzke, Amélie*; Turcot, Valérie; Rouleau, Thérèse; Lavoie, Jean-Claude; Chessex, Philippe*

Journal of Pediatric Gastroenterology & Nutrition: October 2012 - Volume 55 - Issue 4 - p 398–402
doi: 10.1097/MPG.0b013e318258761b
Hepatology and Nutrition

Objectives: The smallest premature neonates often receive blood transfusions early in life. Nonrestrictive transfusion policies are linked to deleterious outcomes. Exposure of total parenteral nutrition (TPN) to ambient light generates oxidation products associated with haemolysis in vitro. Shielding TPN from light limits oxidation. Our hypothesis was protecting TPN from light decreases haemolysis and therefore the need for early blood transfusions.

Methods: Comparison of haemolysis between animals fed enterally and those receiving TPN, and exploratory case-control retrospective analysis of transfusion counts in premature infants receiving light-exposed or light-protected TPN. The statistical analysis was analysis of variance and longitudinal binomial regression model adjusting for potential covariables of transfusion counts.

Results: In animals, TPN is associated with higher (P < 0.05) haemolysis compared with enteral feeds; photoprotection induces lower peroxide load with no effect on the level of haemolysis. In premature infants, light-exposed (n = 76) or light-protected (n = 57) populations exhibited similar clinical characteristics. Initial haematocrit, gestational age, and index of disease severity had a significant effect on the number of transfusions. When adjusting for these covariables, photoprotection was no longer significant.

Conclusions: Even though peroxides are associated in vitro with haemolysis, shielding TPN from light to reduce infused peroxides does not significantly decrease the need for early transfusions in premature infants.

*Department of Pediatrics, Division of Neonatology, Children's and Women's Health Center of BC, Vancouver, BC

Research Center Hospital Ste-Justine, Montreal, QC, Canada.

Address correspondence and reprint requests to Philippe Chessex, Division of Neonatology, Children's and Women's Health Center, 4480 Oak St, Vancouver, BC, Canada V6H 3V4 (e-mail:

Received 14 December, 2011

Accepted 2 April, 2012

This work was supported by the Canadian Institutes of Health Research (CIHR) (MOP 79403). V.T. was the recipient of a studentship award from CIHR.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN