A randomized controlled trial on parenteral nutrition, oxidative stress, and chronic lung diseases in preterm infants.

OBJECTIVES: To evaluate the effect of trace elements (TEs), when added to total parenteral nutrition (TPN) solutions, on peroxides load, and to test the hypothesis that protection of TPN from light can decrease peroxides load and is associated with improvement in oxidant-related clinical outcomes in preterm infants. SUBJECTS AND METHODS: A total of 80 preterm infants were randomized to 1 of 4 groups (n=20 each): group 1 received a mixture of dextrose and amino acids; group 2 received a mixture of dextrose, amino acids, and lipid emulsion; group 3 received dextrose, amino acids, lipid emulsion, and multivitamins (MVP); and group 4 received dextrose, amino acids, lipid emulsion, MVP, and TEs. Each group was subdivided into photo-protected and photo-exposed subgroups (n=10 each). Using ferrous oxidation of xylenol orange technique, we measured the baseline level of excreted urinary peroxides before and 48 hours after starting TPN. We examined the association among light protection, urinary peroxides, and clinical outcomes of these infants. RESULTS: Baseline urinary peroxides ranged between 5.5 and 24.8 micromol/L. A significant increase in urinary peroxides was observed in all groups after receiving TPN. The use of TEs did not affect peroxide production. In regression analysis, the addition of MVP (P<0.0001) and the exposure to light (P=0.02) were significantly associated with increased urinary peroxides. In the overall population, light exposure was associated with a significant increase in the incidence of chronic lung disease (adjusted OR 9.26, confidence interval 1.2-73; P=0.03) but had no effect on mortality, necrotizing enterocolitis, or sepsis. CONCLUSIONS: TEs in TPN solutions have no effect on the production of urinary peroxides. Addition of MVP and exposure of TPN to light are the 2 major sources of peroxides in TPN. Protection from ambient light is associated with a decrease in chronic lung disease.

Dysmorphic Features, Consanguinity and Cytogenetic Pattern of Congenital Heart Diseases: a pilot study from Mansoura Locality, Egypt.

BACKGROUND: Congenital heart diseases (CHD) constitute a common cause of birth defects with a multifactorial inheritance background. OBJECTIVES: to check for the dysmorphic features, consanguinity and cytogenetic pattern that may be associated with congenital heart disease in Egyptian cases from Mansoura, Egypt. METHODS: This work is a pilot prospective controlled study including randomly selected 69 cases affected with congenital heart disease recruited from the Pediatric Cardiology Department, Mansoura University, Egypt. These cases were compared to 500 normal children of matched age and sex taken from the same locality serving as a control group. Complete history taking, clinical examination for dysmorphic features as well as cardiac examination were carried out for all subjects. Furthermore, cases were evaluated by Echocardiography and cytogenetic studies. RESULTS: Egyptian children affected with CHD were significantly associated with positive family history of CHD, perinatal history of maternal diseases or drug intake during pregnancy and positive parental consanguinity (odds ratio = 10.5, 7.6 and 3.1 respectively). Significant associated dysmorphic features included ear anomalies, eye anomalies, cleft lip, polydactyly and cleft palate (odds ratio = 217.6, 176.6, 68.7 and 37.07 respectively). Seven cases (10.1%) had chromosomal aberrations and were associated with dysmorphic features. CONCLUSION: Risk of CHD increased with positive family history and consanguinity. Cytogenetic studies added to dysmorphic features seem to have an important clue for early diagnosis of CHD. Key words: Heart disease, risk factors, dysmorphism, Egypt.