Free radical damage occurs in various neonatal disease states including asphyxia, BPD, NEC & ROP. Lipid peroxidation with lipid hydroperoxides(LHP) & hydrogen peroxide (H2O2) generation can lead to oxidative reactions & tissue damage.

Aim: To determine the extent of LHP and H2O2 generation in routinely uncovered neonatal parenteral lipid & amino acid solutions administered under routine ambient or phototherapy light conditions.

Method/Results: LHP & H2O2 were measured by FOX assay. Before pharmacy preparation mean LHP & H2O2 in different samples of commercial bulk lipid solutions (Intralipid 20%) stored at room temperature (RT) were 92 ± 5 & 99 ± 4umol/L respectively (n = 4). In solutions stored at 2 - 40 C LHP = 10 & 17umol/L H2O2 = 70 & 84umol/L (n = 2). Bulk amino acid (AA) solution(Vaminolact) contained 29 ± 5umol/L of H2O2 (n = 4). Four hours after addition of water & fat soluble vitamins to the RT stored lipid solution in the preparation of parenteral nutrition (PN) solution (n = 4)LHP concentrations increased to 150 ± 12 & H2O2 to 250 ± 20umol/L. With adminstration to infants over 24 hours under phototherapy light conditions concentrations of LHP (274 ± 30umol/L)& H2O2 (573 ± 40umol/L) increased further. Separate addition of electrolytes, trace elements & glucose to the AA solution increased H2O2 to mean 126 ± 20umol/L (n = 4).

Comment: Storage of PN bulk solutions, preparation & routine administration conditions can significantly effect the infused free radical load. The effect of this on neonatal pathology is uncertain.