Protecting TPN and Lipid Infusions from Light: Reducing Hydroperoxides in NICU Patients

2001 ◽  
Vol 20 (2) ◽  
pp. 17-22 ◽  
Author(s):  
Lisa Baird
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Cellular Level ◽  
High Load ◽  
Antioxidant Systems ◽  
Term Infants ◽  
Fat Emulsions ◽  
Patients At Risk ◽  
Intravenous Fat Emulsions

The use of total parenteral nutrition (TPN) and intravenous fat emulsions in sick or preterm infants is often required to maintain adequate nutrition, yet recent research has shown that when exposed to light these nutrients are altered and deliver a high load of exogenous toxic hydroperoxides to already compromised infants. Hydroperoxides cause damage at the cellular level unless mediated by the body’s antioxidant systems. NICU patients are, by definition, patients at risk. Preterm infants have low antioxidant reserves and, like sick term infants, typically suffer significant oxidative stress. Endogenous hydroperoxides alone may overwhelm defenses. The addition of hyperperoxides from light-exposed TPN or fat emulsions increases the risk of tissue damage. Hydroperoxides have been associated with hypoxicischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, chronic lung disease, retinopathy of prematurity, and necrotizing enterocolitis. By protecting these infusates from light, bedside nurses can reduce the amount of hydroperoxides infused and protect NICU patients from the associated risks.

Early Detection of Delayed Myelination in Preterm Infants

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 407-411
Author(s):  
Margot van de Bor ◽  
Gerard L. Guit ◽  
Anneke M. Schreuder ◽  
John Wondergem ◽  
G. Jan Vielvoye
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Resonance Imaging ◽  
Term Infants ◽  
Postmenstrual Age ◽  
The Central Nervous System ◽  
Delayed Myelination

Myelination of the central nervous system can be demonstrated with magnetic resonance imaging. The influence of periventricular-intraventricular hemorrhage and periventricular leukomalacia on cerebral myelination was studied using magnetic resonance imaging. The subjects were 33 preterm infants of less than 30 weeks' gestation studied at 44 weeks' postmenstrual age: 11 infants with periventricular-intraventricular hemorrhage, 7 with periventricular leukomalacia, and 15 without periventricular-intraventricular hemorrhage or periventricular leukomalacia. There were no differences in mean gestational age and birth weight between the three groups. However, infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia had significantly less respiratory distress syndrome. At 44 weeks postmenstrual age, infants with periventricular leukomalacia had a significantly delayed myelination pattern (stage M2) in comparison with infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia and infants with periventricular-intraventricular hemorrhage (stages M3 and M4). The latter two groups had myelination stages that were similar to those of healthy term infants at 44 weeks' postmenstrual age. The results demonstrate that periventricular leukomalacia causes delayed myelination of the cerebrum, whereas periventricular-intraventricular hemorrhage does not.

Intraventricular Hemorrhage and Periventricular Leukomalacia in Preterm Infants

2004 ◽  
Vol 104 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Patrizia Vergani ◽  
Anna Locatelli ◽  
Valentina Doria ◽  
Francesca Assi ◽  
Giuseppe Paterlini ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia

Bone metabolism in very preterm infants receiving total parenteral nutrition: do intravenous fat emulsions have an impact?

2015 ◽  
Vol 73 (12) ◽  
pp. 823-836 ◽  
Author(s):  
Kayla M. Bridges ◽  
Luis Pereira-da-Silva ◽  
Janet C. Tou ◽  
Jane Ziegler ◽  
Luigi Brunetti
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Bone Metabolism ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Fat Emulsions ◽  
Intravenous Fat Emulsions

scholarly journals EFFECT OF INTRAVENOUS FAT EMULSIONS AND INITIAL ENTERAL FEEDING ON APOLIPOPROTEIN CONCENTRATION IN PRETERM INFANTS. † 1911

1996 ◽  
Vol 39 ◽  
pp. 321-321
Author(s):  
David C Usher ◽  
Kathleen Leef ◽  
Robin Davis ◽  
Christie Harris ◽  
Michael L Spear
Keyword(s):  
Preterm Infants ◽  
Enteral Feeding ◽  
Fat Emulsions ◽  
Intravenous Fat Emulsions

Outcome after Asphyxial and Circulatory Disturbances in the Brain

1991 ◽  
Vol 7 (S1) ◽  
pp. 113-117 ◽  
Author(s):  
Malcolm I. Levene
Keyword(s):  
Intraventricular Hemorrhage ◽  
Imaging Techniques ◽  
Periventricular Leukomalacia ◽  
Cellular Level ◽  
Birth Process ◽  
Reasonable Degree ◽  
Definition Of ◽  
The Brain ◽  
Circulatory Disturbances

The first consideration must be an agreed-upon definition of asphyxia. We cannot determine outcome of a condition if some observers are referring to apples and others to pears. Asphyxia is a pathophysiological event comprising both hypoperfusion and hypoxia, and these events result in compromise at a cellular level with the production of metabolic acids. This can be due to a wide number of insults, but a complication of the birth process is the most important cause. Asphyxia is not like intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), as these are conditions that can be diagnosed with a reasonable degree of precision with imaging techniques.

scholarly journals ‘‘Intraventricular’’ Hemorrhage and Cystic Periventricular Leukomalacia in Preterm Infants: How Are They Related?

2009 ◽  
Vol 24 (9) ◽  
pp. 1158-1170 ◽  
Author(s):  
Cynthia D. J. Kusters ◽  
Minghua L. Chen ◽  
Pamela L. Follett ◽  
Olaf Dammann
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia

Value of Cranial Ultrasound and Magnetic Resonance Imaging in Predicting Neurodevelopmental Outcome in Preterm Infants

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 196-199
Author(s):  
Margot van de Bor ◽  
Lya den Ouden ◽  
Gerard L. Guit
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Predictive Factor ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Neurodevelopmental Outcome ◽  
Cranial Ultrasound ◽  
Resonance Imaging ◽  
Postmenstrual Age

In this prospective study, cranial ultrasound was performed to detect periventricular-intraventricular hemorrhage and periventricular leukomalacia in 33 preterm infants of less than 32 weeks' gestation. At 44 weeks postmenstrual age magnetic resonance imaging was performed to detect the stage of myelination. Neurodevelopmental outcome was assessed at 3 years of age in 31 children (2 children died in the first year of life). Significant correlations were found between neurodevelopmental outcome and ultrasound findings (χ2 = 32.8; P < .0001) and stage of myelination (χ2 = 20.5; P < .0005). To establish the criterion with the best predictive factor, multiple regression analysis was performed with outcome as dependent variable and periventricular-intraventricular hemorrhage, periventricular leukomalacia, and stage of myelination as independent variables. It appeared that the detection of periventricular leukomalacia with ultrasound showed the best predictive factor for neurodevelopmental outcome. Routine magnetic resonance imaging at 44 weeks postmenstrual age should not be performed just for the purpose of predicting neurodevelopmental outcome more reliably.

Bilateral Cystic Periventricular Leukomalacia in the Premature Infant: Associated Risk Factors

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 822-827 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
Rick Risser ◽  
R. Sue Broyles
Keyword(s):  
Positive Predictive Value ◽  
Premature Infant ◽  
Preterm Infants ◽  
Predictive Value ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Univariate Analysis ◽  
Cranial Ultrasound ◽  
Ultrasound Screening ◽  
Increased Risk

Background. Bilateral cystic periventricular leukomalacia (PVL) is a major cause of neurodevelopmental delay in the premature infant. Thus, early identification of the preterm infant at highest risk for the subsequent development of this lesion is critical. Objectives. The three objectives of this case-control study were: (1) to determine the basic characteristics of cystic PVL, (2) to assess the relationship of perinatal clinical events and PVL, and (3) to ascertain the feasibility of identifying early those preterm infants at highest risk for the development of PVL. Methods. The medical records and cranial ultrasound scans (HUSs) were reviewed for 632 infants weighing less than 1750 g who were admitted to the neonatal intensive care unit between January 1992 and December 1993. PVL developed in 14 infants of 1285 ± 301 g birth weight (BW) and 29.4 ± 1.5 weeks' gestational age (GA); severe intraventricular hemorrhage (n = 21) and intraparenchymal echodensity (n = 12) developed in 33 infants of 904 ± 248 g BW and 26.6 ± 1.8 weeks' GA; and 585 infants of 1315 ± 324 g BW and 29.7 ± 2.4 weeks' GA with normal HUS findings (n = 473) or grade I or II intraventricular hemorrhage (n = 112) served as a comparison group. Results. Cystic PVL was observed in 14 (2.3%) of 632 infants weighing less than 1750 g, more specifically, in 3.2% of infants weighing less than 1500 g. Cysts were noted from the 7th to 14th days of life in 10 infants and from the 20th to 46th days of life in 4 infants. Ten (70%) of the infants had relatively benign clinical courses, and most cases were detected by routine HUS surveillance. Overt hypotension in the immediate perinatal period was noted in 3 (21%) infants; late hypotension developed in 1 additional infant. Univariate analysis indicate that two clinical indicators, prolonged rupture of membranes (PROM) and chorioamnionitis, were significant predictors of PVL. For PROM, the odds ratio estimate and the 95% confidence limit are 6.59 and 1.96 to 22.10, with a sensitivity of 28.6% and positive predictive value of 11.5%. Similar values for chorioamnionitis are 6.77 (1.77 to 25.93), with a sensitivity of 21.4% and positive predictive value of 11.5%. Conclusions. (1) Most cases of symmetric cystic PVL occurred in infants with relatively benign clinical courses and were only detected by routine ultrasound screening. (2) Postnatal systemic hypotension seems to be an uncommon associated event. (3) Preterm infants born to mothers with PROM and/or chorioamnionitis seem to be at an increased risk for the development of PVL and should be carefully evaluated.

Behavioral Responsiveness in Preterm Infants With Intraventricular Hemorrhage

PEDIATRICS ◽  
1988 ◽  
Vol 81 (3) ◽  
pp. 412-418
Author(s):  
Cynthia T. Garcia-Coll ◽  
Laura Emmons ◽  
Betty R. Vohr ◽  
Alison Monds Ward ◽  
Benjamin S. Brann ◽  
...  
Keyword(s):  
Individual Differences ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Activity Levels ◽  
Term Infants ◽  
Behavioral Observations ◽  
Tactile Stimuli ◽  
Behavioral Responsiveness ◽  
Grade Ii ◽  
Parental Reports

Preterm infants with varying degrees of intraventricular hemorrhage (none, n = 21; grade I to II, n = 22; grade II to IV, n = 24) and a group of full-term infants (n = 21) were compared with regard to behavioral responsiveness and parental reports of the infant's temperament. Behavioral responsiveness was assessed during the presentation of 15 visual, auditory, and tactile stimuli at 3 months of age (corrected age for preterm infants). Summary scores for positive and negative responsiveness, as well as sociability, soothability, and overall activity levels, were derived from behavioral observations by coders who were unaware of the infant's characteristics. The Bates Infant Characteristic Questionnaire was completed by the main care giver and scored on four summary variables: fussy-difficult, unadaptable, dull, and unpredictable. Preterm infants, regardless of the presence or severity of intraventricular hemorrhage, showed less positive responses and less overall activity in response to stimulation. Infants with grade I to II intraventricular hemorrhage were less sociable and more difficult to soothe than fullterm control infants. Individual differences in positive, negative, sociability, and soothability were related to the questionnaire scores of fussy-difficult and unadaptability. Both prematurity and degree of intraventricular hemorrhage affect behavioral responsiveness and these individual differences are related to parental reports of the infant's temperament.

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