Protecting TPN and lipid infusions from light: reducing hydroperoxides in NICU patients.

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 hypoxic-ischemic 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.