1
|
Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JV, Swann J, Johnson MJ, Beattie RM. A Scoping Review: Urinary Markers of Metabolic Maturation in Preterm Infants and Future Interventions to Improve Growth. Nutrients 2022; 14:nu14193957. [PMID: 36235609 PMCID: PMC9571892 DOI: 10.3390/nu14193957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Growth failure in infants born preterm is a significant issue, increasing the risk of poorer neurodevelopmental outcomes and metabolic syndrome later in life. During the first 1000 days of life biological systems mature rapidly involving developmental programming, cellular senescence, and metabolic maturation, regulating normal growth and development. However, little is known about metabolic maturation in infants born preterm and the relationship with growth. Objective: To examine the available evidence on urinary markers of metabolic maturation and their relationship with growth in infants born preterm. Eligibility criteria: Studies including in this scoping review using qualitative or quantitative methods to describe urinary markers of metabolic maturation and the relationship with growth in infants born preterm. Results: After a screening process 15 titles were included in this review, from 1998–2021 drawing from China (n = 1), Italy (n = 3), Germany (n = 3), Greece (n = 1), Japan (n = 2), Norway (n = 1), Portugal (n = 1), Spain (n = 2) and USA (n = 1). The included studies examined urinary metabolites in 1131 infants. A content analysis identified 4 overarching themes relating to; (i) metabolic maturation relative to gestational age, (ii) metabolic signature and changes in urinary metabolites over time, (iii) nutrition and (iv) growth. Conclusion: The results of this scoping review suggest there are considerable gaps in our knowledge relating to factors associated with metabolic instability, what constitutes normal maturation of preterm infants, and how the development of reference phenome age z scores for metabolites of interest could improve nutritional and growth outcomes.
Collapse
Affiliation(s)
- Luise V. Marino
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Health Science, University of Southampton, Southampton SO17 1BJ, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Correspondence: ; Tel.: +44-(0)-23-8079-6000
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - James J. Ashton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - Aneurin Young
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - John V. Pappachan
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Jonathan Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Mark J. Johnson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Robert Mark Beattie
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
| |
Collapse
|
2
|
Lavoie JC, Chessex P. Parenteral nutrition and oxidant stress in the newborn: A narrative review. Free Radic Biol Med 2019; 142:155-167. [PMID: 30807828 DOI: 10.1016/j.freeradbiomed.2019.02.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 01/27/2023]
Abstract
There is strong evidence that oxidant molecules from various sources contaminate solutions of parenteral nutrition following interactions between the mixture of nutrients and some of the environmental conditions encountered in clinical practice. The continuous infusion of these organic and nonorganic peroxides provided us with a unique opportunity to study in cells, in vascular and animal models, the mechanisms involved in the deleterious reactions of oxidation in premature infants. Potential clinical impacts of peroxides infused with TPN include: a redox imbalance, vasoactive responses, thrombosis of intravenous catheters, TPN-related hepatobiliary complications, bronchopulmonary dysplasia and mortality. This is a narrative review of published data.
Collapse
Affiliation(s)
- Jean-Claude Lavoie
- Centre de Recherche Hôpital Ste-Justine, Department of Nutrition, University of Montreal, Montreal, QC, Canada
| | - Philippe Chessex
- Division of Neonatology, Department of Pediatrics, Children's and Women's Health Center of British Columbia, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Peña-Bautista C, Durand T, Vigor C, Oger C, Galano JM, Cháfer-Pericás C. Non-invasive assessment of oxidative stress in preterm infants. Free Radic Biol Med 2019; 142:73-81. [PMID: 30802488 DOI: 10.1016/j.freeradbiomed.2019.02.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/22/2022]
Abstract
Preterm newborns have an immature antioxidant defense system and are especially susceptible to oxidative stress. Resuscitation, mechanical ventilation, intermittent hypoxia and apneic episodes require frequently oxygen supplementation which leads to oxidative stress in preterm newborns. The consequences of oxidative damage are increased short and long-term morbidities, neurodevelopmental impairment and increased mortality. Oxidative stress biomarkers are determined in blood samples from preterm children during their stay in neonatal intensive care units especially for research purposes. However, there is a tendency towards reducing invasive and painful techniques in the NICU (Neonatal Intensive Care Unit) and avoiding excessive blood extractions procedures. In this paper, it has been described some studies that employed non-invasive samples to determine oxidative stress biomarkers form preterm infants in order to perform a close monitoring biomarker with a significant greater predictive value. Among these methods we describe a previously developed and validated high-performance liquid chromatography tandem mass spectrometry method that allow to accurately determine the most reliable biomarkers in biofluids, which are non-invasively and painlessly obtained.
Collapse
Affiliation(s)
| | - Thierry Durand
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | - Claire Vigor
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | - Camille Oger
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | - Jean-Marie Galano
- Institut des Biomolécules Max Mousseron, IBMM, University of Montpellier, CNRS ENSCM, Montpellier, France
| | | |
Collapse
|
4
|
Martin A, Faes C, Debevec T, Rytz C, Millet G, Pialoux V. Preterm birth and oxidative stress: Effects of acute physical exercise and hypoxia physiological responses. Redox Biol 2018; 17:315-322. [PMID: 29775962 PMCID: PMC6006904 DOI: 10.1016/j.redox.2018.04.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/16/2018] [Accepted: 04/30/2018] [Indexed: 12/31/2022] Open
Abstract
Preterm birth is a global health issue that can induce lifelong medical sequela. Presently, at least one in ten newborns are born prematurely. At birth, preterm newborns exhibit higher levels of oxidative stress (OS) due to the inability to face the oxygen rich environment in which they are born into. Moreover, their immature respiratory, digestive, immune and antioxidant defense systems, as well as the potential numerous medical interventions following a preterm birth, such as oxygen resuscitation, nutrition, phototherapy and blood transfusion further contribute to high levels of OS. Although the acute effects seem well established, little is known regarding the long-term effects of preterm birth on OS. This matter is especially important given that chronically elevated OS levels may persist into adulthood and consequently contribute to the development of numerous non-communicable diseases observed in people born preterm such as diabetes, hypertension or lung disorders. The purpose of this review is to summarize the current knowledge regarding the consequences of preterm birth on OS levels from newborn to adulthood. In addition, the effects of physical activity and hypoxia, both known to disrupt redox balance, on OS modulation in preterm individuals are also explored.
Collapse
Affiliation(s)
- Agnès Martin
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne, France; Master BioSciences, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, Univ Lyon, France
| | - Camille Faes
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne, France; Laboratory of Excellence GR-Ex, Paris, France
| | - Tadej Debevec
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia; Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Chantal Rytz
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grégoire Millet
- ISSUL, Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Vincent Pialoux
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne, France; Institut Universitaire de France, Paris, France; Laboratory of Excellence GR-Ex, Paris, France.
| |
Collapse
|
5
|
Rugolo LMSDS, de Sá MPA, Kurokawa CS, Madoglio RJ, Bentlin MR, Rugolo A, Corrente JE. There is no difference in nitric oxide metabolites and neonatal outcome between premature infants born to pre-eclamptic and those born to normotensive women. Paediatr Int Child Health 2015; 35:47-52. [PMID: 25547177 DOI: 10.1179/2046905514y.0000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The pathophysiology of pre-eclampsia (PE) is complex, and nitric oxide (NO) may be a factor. The neonatal outcome in pregnancies complicated by PE is controversial, and the PE/NO/neonatal diseases relationship has not been well established. AIMS To measure nitrate and nitrite levels in the placenta, umbilical cord blood, blood and urine of preterm neonates born to pre-eclamptic and normotensive women and to investigate the relationship between placental, fetal and neonatal NO metabolites and neonatal outcome. METHODS A prospective study was undertaken of 30 preterm infants <34 weeks of gestation, born to pre-eclamptic mothers and matched by gestational age with 30 infants born to normotensive mothers. Samples from the placental tissue, venous cord blood and the newborns' blood on day 4 and urine on days 1 and 4 were assayed for NO metabolites (nitrate and nitrite). Clinical variables and NO metabolites were compared between the groups. Generalised linear models were fitted to associate NO metabolites levels with adverse neonatal outcomes. RESULTS There were no differences in NO metabolites and neonatal outcomes between the two groups. Increased levels of NO metabolites were found in the placenta and cord blood of small-for-gestational-age infants, and in the cord blood of newborns with necrotising enterocolitis and those who died. CONCLUSION NO metabolite levels in the placenta and fetal and neonatal circulation were not associated with PE; however, cord blood levels of NO metabolites differed according to fetal growth and neonatal outcome.
Collapse
|
6
|
Ballard PL, Keller RL, Black DM, Durand DJ, Merrill JD, Eichenwald EC, Truog WE, Mammel MC, Steinhorn R, Ryan RM, Courtney SE, Horneman H, Ballard RA. Inhaled nitric oxide increases urinary nitric oxide metabolites and cyclic guanosine monophosphate in premature infants: relationship to pulmonary outcome. Am J Perinatol 2015; 32:225-32. [PMID: 24968129 PMCID: PMC5032843 DOI: 10.1055/s-0034-1382255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Inhaled nitric oxide (iNO) has been tested to prevent bronchopulmonary dysplasia (BPD) in premature infants, however, the role of cyclic guanosine monophosphate (cGMP) is not known. We hypothesized that levels of NO metabolites (NOx) and cGMP in urine, as a noninvasive source for biospecimen collection, would reflect the dose of iNO and relate to pulmonary outcome. STUDY DESIGN Studies were performed on 125 infants who required mechanical ventilation at 7 to 14 days and received 24 days of iNO at 20-2 ppm. A control group of 19 infants did not receive iNO. RESULTS In NO-treated infants there was a dose-dependent increase of both NOx and cGMP per creatinine (maximal 3.1- and 2-fold, respectively, at 10-20 ppm iNO) compared with off iNO. NOx and cGMP concentrations at both 2 ppm and off iNO were inversely related to severity of lung disease during the 1st month, and the NOx levels were lower in infants who died or developed BPD at term. NOx was higher in Caucasian compared with other infants at all iNO doses. CONCLUSION Urinary NOx and cGMP are biomarkers of endogenous NO production and lung uptake of iNO, and some levels reflect the severity of lung disease. These results support a role of the NO-cGMP pathway in lung development.
Collapse
Affiliation(s)
- Philip L. Ballard
- Department of Pediatrics, University of California, San Francisco, California
| | - Roberta L. Keller
- Department of Pediatrics, University of California, San Francisco, California
| | - Dennis M. Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - David J. Durand
- Division of Neonatology, Children’s Hospital and Research Center Oakland, Oakland, California
| | - Jeffrey D. Merrill
- Division of Neonatology, Children’s Hospital and Research Center Oakland, Oakland, California
| | - Eric C. Eichenwald
- Department of Pediatrics, University of Texas Medical School, Houston, Texas
| | - William E. Truog
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Mark C. Mammel
- Department of Pediatrics, Children’s Hospital and Clinics of Minnesota, St. Paul, Minnesota
| | - Robin Steinhorn
- Department of Pediatrics, University of California Davis Children’s Hospital, Sacramento, California
| | - Rita M. Ryan
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Sherry E. Courtney
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hart Horneman
- Department of Pediatrics, University of California, San Francisco, California
| | - Roberta A. Ballard
- Department of Pediatrics, University of California, San Francisco, California
| | | |
Collapse
|
7
|
Şimşek Y, Karabiyik P, Polat K, Duran Z, Polat A. Mode of delivery changes oxidative and antioxidative properties of human milk: a prospective controlled clinical investigation. J Matern Fetal Neonatal Med 2014; 28:734-8. [PMID: 24903065 DOI: 10.3109/14767058.2014.932345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the influence of delivery mode on oxidative stress in human breast milk. METHODS Thirty-three women who delivered by vaginal birth and 55 women who underwent cesarean section (CS) were included in this study. Colostral samples were collected on the second day after delivery. Total antioxidative status (TAS), total oxidative status (TOS), oxidative stress index (OSI), malonyldialdehyde (MDA), and glutathione peroxidase (GSH-Px) levels were determined and compared. RESULTS Colostrum TAS was significantly higher in women of vaginal birth, than in women with CS (p < 0.001). Milk TOS and OSI were found to be significantly increased in women with CS under general anesthesia. A marked increase in colostral GSH-Px levels after vaginal delivery was also noticed (p < 0.001). CONCLUSION This study revealed that vaginal birth is associated with decreased oxidative stress in colostrum than CS, which suggest that mode of delivery plays an important role in the antioxidative production of breast milk.
Collapse
Affiliation(s)
- Yavuz Şimşek
- Department of Obstetrics and Gynecology, Kırıkkale University Faculty of Medicine , Kırıkkale , Turkey
| | | | | | | | | |
Collapse
|
8
|
Aranke M, Mian AI. A Biomarker-Based Approach to Infectious Disease in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013; 14:95-101. [PMID: 32288643 PMCID: PMC7105964 DOI: 10.1016/j.cpem.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In modern pediatric emergency medicine, biomarker-based assays that enable quick bedside diagnostics and subsequent disease management can be valuable. There is a growing need for novel, disease-specific biomarkers that can improve the outcome of pediatric infectious diseases commonly encountered in the emergency department (ED). Viral respiratory infections, central nervous system infections, sepsis, and septic shock are acute disease states frequently encountered in the ED. In this review, we describe a host of novel biomarkers, including a diverse set of cytokines, chemokines, and nitric oxide–based metabolites. Based on disease pathophysiology, a rationale is provided for a molecular- or biomarker-based approach in the ED. Throughout this review, emphasis is placed on diagnostic rapidity because this relates directly to timeliness and quality of care in a busy ED. Once the biomarkers become more clinically available, in a rapid ED setting as bedside point-of-care assays, quality of care will be enhanced, not only by means of diagnostics but also in prognosticating severity of illness.
Collapse
Affiliation(s)
- Mayank Aranke
- College of Natural Sciences, University of Texas-Austin, University Station, Austin, TX
| | - Asad I Mian
- Department of Pediatrics, Section of Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| |
Collapse
|
9
|
Mian AI, Aranke M, Bryan NS. Nitric oxide and its metabolites in the critical phase of illness: rapid biomarkers in the making. Open Biochem J 2013; 7:24-32. [PMID: 23539501 PMCID: PMC3606948 DOI: 10.2174/1874091x01307010024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/28/2012] [Accepted: 11/28/2012] [Indexed: 02/06/2023] Open
Abstract
The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable in several body compartments and fluids, and as such they are associated with many of the pathophysiological processes mentioned above. With methods such as high performance liquid chromatography and chemiluminescence these entities are relatively easy and inexpensive to analyze. Emphasis is placed on diagnostic rapidity, as this relates directly to quality of care in acute care situations. Further, a rationale is provided for more bench, translational and clinical research in the field of NO biomarkers for such settings. Developing standard protocols for the aforementioned disease states, centered on concentrations of NO and its metabolites, can prove to revolutionize diagnostics and prognostication along a spectrum of clinical care. We present a strong case for developing these biomarkers more as point-of-care assays with potential of color gradient test strips for rapid screening of disease entities in acute care and beyond. This will be relevant to global health.
Collapse
Affiliation(s)
- Asad I Mian
- Dept of Pediatrics, Section of Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston TX 77030
| | | | | |
Collapse
|
10
|
Early assessment of the severity of asphyxia in term newborns using parameters of blood count. Interdiscip Toxicol 2011; 1:211-3. [PMID: 21218117 PMCID: PMC2994022 DOI: 10.2478/v10102-010-0043-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 10/10/2008] [Accepted: 10/15/2008] [Indexed: 11/21/2022] Open
Abstract
Acute perinatal asphyxia is a major cause of death and neurological injury in newborn infants. Severe asphyxia can occur in infants around the time of birth for several reasons. The aim of our study was to find the most sensitive, easily obtainable and fast assessable parameter of the presence and quantification of asphyxia. In our study 39 term newborns (15 healthy term newborns and 24 asphyxial term newborns), from vaginal deliveries admitted within 24 hours of life were monitored and parameters of blood count from venous blood were assessed. Laboratory findings of blood count parameters revealed significant differences between term asphyxial and healthy newborns in erythrocyte count and hemoglobin and hematocrit values. Hematological changes observed early after delivery can determine the duration of hypoxemia (acute vs. chronic) and asphyxia of short duration may be accompanied without occurrence of polyglobulia.
Collapse
|
11
|
Friel JK, Diehl-Jones B, Cockell KA, Chiu A, Rabanni R, Davies SS, Roberts LJ. Evidence of oxidative stress in relation to feeding type during early life in premature infants. Pediatr Res 2011; 69:160-4. [PMID: 21045751 DOI: 10.1203/pdr.0b013e3182042a07] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Morbidity in the premature (PT) infant may reflect difficult adaptation to oxygen. We hypothesized that feeding including formula feeding (F) and feeding mother's milk (HM) with added fortifier would affect redox status. Therefore, 65 PT infants (birth weight: 1146 ± 261 g; GA: 29 ± 2.5 wk; mean ± SD) were followed biweekly, once oral feeds were introduced. Feeding groups: F (>75% total feeds) and HM (>75% total feeds) were further subdivided according to human milk fortifier (HMF) content of 0-19, 20-49, and ≥ 50%. Oxidative stress was quantified by F2-isoprostanes (F2-IsoPs) in urine, protein carbonyls, and oxygen radical absorbance capacity (ORAC) in plasma. F2-IsoPs (ng/mg creatinine): 0-2 wk, 125 ± 63; 3-4 wk, 191 ± 171; 5-6 wk, 172 ± 83; 7-8 wk, 211 ± 149; 9-10 wk, 222 ± 121; and >10 wk, 183 ± 67. Protein carbonyls from highest [2.41 ± 0.75 (n = 9)] and lowest [2.25 ± 0.89 (n = 12) pmol/μg protein] isoprostane groups did not differ. ORAC: baseline, 6778 ± 1093; discharge, 6639 ± 735 [full term 4 and 12 M, 9010 ± 600 mg (n = 12) TE]. Highest isoprostane values occurred in infants with >50% of their mother's milk fortified. Further research on HMF is warranted.
Collapse
Affiliation(s)
- James K Friel
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada.
| | | | | | | | | | | | | |
Collapse
|
12
|
Ledo A, Arduini A, Asensi MA, Sastre J, Escrig R, Brugada M, Aguar M, Saenz P, Vento M. Human milk enhances antioxidant defenses against hydroxyl radical aggression in preterm infants. Am J Clin Nutr 2009; 89:210-5. [PMID: 19056604 DOI: 10.3945/ajcn.2008.26845] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm infants endowed with an immature antioxidant defense system are prone to oxidative stress. Hydroxyl radicals are very aggressive reactive oxygen species that lack specific antioxidants. These radicals cannot be measured directly, but oxidation byproducts of DNA or phenylalanine in urine are reliable markers of their activity. Human milk has a higher antioxidant capacity than formula. OBJECTIVE We hypothesized that oxidative stress associated with prematurity could be diminished by feeding human milk. DESIGN We recruited a cohort of stable preterm infants who lacked perinatal conditions associated with oxidative stress; were not receiving prooxidant or antioxidant drugs, vitamins, or minerals before recruitment; and were fed exclusively human milk (HM group) or preterm formula (PTF group). Collected urine was analyzed for oxidative bases of DNA [8-hydroxy-2'-deoxyguanosine (8-oxodG)/2'-deoxyguanosine (2dG) ratio] and oxidative derivatives of phenylalanine [ortho-tyrosine (o-Tyr)/Phe ratio] by HPLC coupled to tandem mass spectrometry. Healthy term newborn infants served as control subjects. RESULTS Both preterm groups eliminated greater amounts of metabolites than did the control group. However, the PTF group eliminated significantly (P < 0.02) higher amounts of 8-oxodG (8-oxodG/2dG ratio: 10.46 +/- 3.26) than did the HM group (8-oxodG/2dG ratio: 9.05 +/- 2.19) and significantly (P < 0.01) higher amounts of o-Tyr (o-Tyr/Phe ratio: 14.90 +/- 3.75) than did the HM group (o-Tyr/Phe ratio: 12.53 +/- 3.49). When data were lumped together independently of the type of feeding received, a significant correlation was established between the 8-oxodG/2dG and o-Tyr/Phe ratios in urine, dependent on gestational age and birth weight. CONCLUSION Prematurity is associated with protracted oxidative stress, and human milk is partially protective.
Collapse
Affiliation(s)
- Ana Ledo
- Division of Neonatology, Hospital Universitario Materno Infantil La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Richir MC, van Leeuwen PAM, van den Berg A, Wessels R, Twisk JWR, Rauwerda JA, Teerlink T, de Vries TPGM, van Elburg RM. Plasma ADMA concentrations at birth and mechanical ventilation in preterm infants: a prospective pilot study. Pediatr Pulmonol 2008; 43:1161-6. [PMID: 18991340 DOI: 10.1002/ppul.20886] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
RATIONALE Nitric oxide (NO) produced in the lung is an important mediator of normal lung development, vascular smooth muscle relaxation, and ventilation perfusion matching. NO is synthesized from arginine by the action of NO-synthase (NOS). Asymmetric dimethylarginine (ADMA), an endogenous derivate of arginine, inhibits NOS and is thereby a determinant of NO synthesis. We compared ADMA and arginine levels in preterm infants requiring mechanical ventilation with preterm infants who did not require mechanical ventilation and determined the relation between ADMA and the length of mechanical ventilation in these infants. METHODS Thirty preterm infants, mean (SD) gestational age 29.3 (1.7) weeks and birth weight 1,340 (350) gram, of the Neonatal Intensive Care Unit of the VU University Medical Center were included. ADMA and arginine were measured in umbilical cord blood and the length of mechanical ventilation (days) was registered. RESULTS Gestational age and birth weight were significantly smaller in infants requiring mechanical ventilation, but were not significantly correlated with plasma ADMA concentration after birth. Plasma ADMA concentrations were significantly higher in infants who required mechanical ventilation than in infants who did not require mechanical ventilation (1.53 +/- 0.23 and 1.37 +/- 0.14 micromol/L, respectively; P = 0.036). ADMA concentration was significantly related to length of mechanical ventilation (B = 3.4; 95% CI: 1.1-5.6; P = 0.006), also after adjustment for gestational age (B = 2.3; 95% CI: 0.4-4.2; P = 0.024). CONCLUSIONS Preterm infants who require mechanical ventilation have increased ADMA levels compared to non-ventilated preterm infants. ADMA levels at birth are related to the length of mechanical ventilation. An increased ADMA concentration could reduce NO synthesis, which could lead to insufficient gas exchange and, consequently, a longer period of mechanical ventilation.
Collapse
Affiliation(s)
- Milan C Richir
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Davis CW, Gonzales LW, Ballard RA, Ballard PL, Guo C, Gow AJ. Expression of nitric oxide synthases and endogenous NO metabolism in bronchopulmonary dysplasia. Pediatr Pulmonol 2008; 43:703-9. [PMID: 18500734 PMCID: PMC4015107 DOI: 10.1002/ppul.20848] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bronchopulmonary dysplasia (BPD), a multifactorial disease of preterm neonates of complex etiology, is a significant problem within very low birth weight infants. Nitric oxide (NO) has been implicated in both the pathogenesis and as a potential therapeutic of this disease. At this time, there is little direct evidence of the changes in NO production and metabolism that occur within BPD in humans. Animal models have implied that reduced nitric oxide synthase (NOS) expression and NO production in the early stages of the disease may be critical factors. However, inflammation and hence iNOS expression, is also thought to play a role. In the present study we have utilized pathological samples to determine changes in the expression of NOS and NO metabolites within late stage BPD. It is our contention that within these samples iNOS expression is increased and associated with increased NO metabolite production. Mild immunostaining of all three nitric oxide synthase (NOS) enzymes (neuronal, inducible and endothelial) is observed in control lung with tight localization to the endothelium and epithelial airway. This tight localization was lost in samples from subjects with BPD. There was also a marked increase in iNOS expression throughout the lung tissue with strong coexistence with an epithelial cell marker cytokeratin. NO reaction products are altered with BPD as evidenced by increased S-nitrosothiol (SNO) and strong nitrotyrosine (NO(2)Y) imunoreactivity. This study demonstrates a strong correlation between products of NO reactivity and NOS localization in BPD.
Collapse
Affiliation(s)
- Christiana W Davis
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Oxidative stress plays an important role in causing organ injury in the compromised fetus and neonate. Recent experimental research and clinical studies have clarified important pathways in the production of reactive oxygen and nitrogen species. Free radicals are involved in causing cerebral damage after perinatal hypoxia-ischemia affecting membrane lipids, proteins, and DNA. Anti-oxidant strategies can be used as add-on neuroprotective therapy after perinatal oxidative stress. Selective inhibitors of neuronal and inducible nitric oxide synthase, allopurinol, melatonin, and erythropoietin are among the first compounds that are ready for clinical trials.
Collapse
Affiliation(s)
- Giuseppe Buonocore
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, viale Bracci 36, Siena, Italy.
| | | |
Collapse
|