title: Influence of shielding TPN from photooxidation on the number of early blood transfusions in ELBW premature neonates.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Children's and Women's Health Center of BC, Vancouver, BC, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Stritzke
authors.forename: Valérie
authors.initials: V
authors.lastname: Turcot
authors.forename: Thérèse
authors.initials: T
authors.lastname: Rouleau
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Lavoie
authors.forename: Philippe
authors.initials: P
authors.lastname: Chessex
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001803:Blood Transfusion; D016022:Case-Control Studies; D004750:Enteral Nutrition; D005260:Female; D005865:Gestational Age; D006168:Guinea Pigs; D006400:Hematocrit; D006461:Hemolysis; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D008027:Light; D008297:Male; D010084:Oxidation-Reduction; D010289:Parenteral Nutrition, Total; D010545:Peroxides / Q000097:blood; D011835:Radiation Protection; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D010545:Peroxides