Vitamin C is reduced in human milk after storage.

UNLABELLED: In order to establish how cold storage of human milk affects levels of bioavailable vitamin C, 11 samples were stored for 24 h in the refrigerator or up to 2 mo in the freezer. Total vitamin C levels decreased on average by one-third in the refrigerator or after I mo of freezing, with wide variations between individuals (6 to 76% and 3 to 100%, respectively). After 2 mo of freezing, the average decrease was two-thirds (7-100%). CONCLUSION: We recommend a change in human milk storage practices, to under 24 h in a refrigerator or under 1 mo in a freezer. Alternatively, vitamin C supplementation may be considered.

Protein carbonyls and lipid peroxidation products as oxidation markers in preterm infant plasma: associations with chronic lung disease and retinopathy and effects of selenium supplementation.

The purpose of this study was to determine whether protein carbonyls and the lipid peroxidation product malondialdehyde (MDA) are elevated in plasma from very low birth weight (<1500 g) infants, whether they are affected by selenium supplementation, and whether they are associated with poor respiratory outcome or retinopathy. The study group comprised 173 infants enrolled in a randomized controlled trial of selenium supplementation. Plasma samples, collected before randomization, at 7 and 28 d after birth, and at 36 wk postmenstrual age, were analyzed for protein carbonyls and total MDA. Respiratory outcome was assessed as oxygen requirement at 28 d of age or 36 wk postmenstrual age and as number of days on oxygen. Protein carbonyl concentrations in very low birth weight infants were significantly higher than for adults but lower than for cord blood from term infants. Median values decreased significantly by 28 d, and there was no relationship with birth weight. MDA concentrations in very low birth weight infants overlapped the ranges for healthy adults and cord blood from term infants. They correlated positively with birth weight at 28 d but not at other times. Supplementation almost doubled plasma selenium concentrations, but carbonyls and MDA did not differ between the supplemented and unsupplemented groups. There were no significant differences in oxidant marker levels in infants who did or did not develop chronic lung disease or retinopathy. Protein carbonyls and MDA measurements in plasma do not show evidence of systemic oxidative stress in <1500-g infants and are not affected by selenium supplementation. Oxidative injury at sites such as the lung may be important in prematurity, but markers from such sites must be measured to relate to outcome and antioxidant supplementation.

Elevated protein carbonyls and lipid peroxidation products correlating with myeloperoxidase in tracheal aspirates from premature infants.

The purpose of this study is to determine whether the oxidative injury markers, protein carbonyls and malondialdehyde (MDA), are elevated in tracheal aspirates from very low birth weight (< 1500 g) infants; to determine whether levels correlate with myeloperoxidase as a marker of neutrophil inflammation; and to assess whether high levels are associated with poor respiratory outcome. Tracheal aspirates (144 samples) were collected from 86 infants < 1500 g at times of routine suctioning. Aspirates (82 samples) from 54 infants > or = 1500 g who required intubation for a variety of diagnoses were analyzed for comparison. Analyses were performed for protein carbonyls by ELISA, total malondialdehyde by HPLC, and myeloperoxidase activity. Respiratory outcome was assessed as oxygen requirement at 28-d or 36-wk postmenstrual age, and as the number of days of oxygen requirement. Protein carbonyls were significantly higher in infants < 1500 g than larger infants, and were highest close to birth. MDA concentrations were also higher in the earlier samples. There was a strong positive correlation between protein carbonyls and myeloperoxidase, suggesting a link between protein oxidation and neutrophil activation. A similar but weaker correlation was seen for MDA. Carbonyls in samples taken after steroid administration were less than for controls with a similar age distribution. We did not see significant associations between oxidant marker levels and development of chronic lung disease. Our findings of higher amounts of protein and lipid oxidation products in tracheal aspirates with high myeloperoxidase activity, taken together with other studies showing a link between neutrophil accumulation and chronic lung disease, suggest a possible contribution by neutrophil-derived reactive oxygen species to the injury.

Protein carbonyl measurements show evidence of early oxidative stress in critically ill patients.

OBJECTIVE: To determine whether there is evidence of oxidative injury in patients who are critically ill with severe sepsis or major trauma, by measuring protein and lipid oxidation products. DESIGN: A prospective, observational study. SETTING: Critical care unit at a university teaching hospital. PATIENTS: Twenty-two patients with severe sepsis (Acute Physiology and Chronic Health Evaluation II score 15-34) and eight patients with major trauma (Injury Severity Score 26-50). INTERVENTIONS: Plasma and bronchoalveolar lavage fluid was collected regularly during the first 10 days after trauma or onset of sepsis. Both fluids were analyzed for protein carbonyl concentrations as a measure of protein oxidation and thiobarbituric acid-reactive substances as a measure of lipid peroxidation. Myeloperoxidase concentrations were measured as an index of neutrophil activation. MEASUREMENTS AND MAIN RESULTS: Protein carbonyl concentrations were initially highly elevated compared with those in healthy adults in the plasma of both patient groups. They fell significantly within the first few days but remained above control values. Protein carbonyl concentrations were also high initially in bronchoalveolar lavage fluid and fell significantly with time. Thiobarbituric acid-reactive substances were not increased in plasma, and varied over a wide concentration range in lavage fluid. Myeloperoxidase activity reached micromolar levels in the lavage fluid when corrected for dilution, and was significantly higher in the plasma of the sepsis patients who subsequently died. There was a strong correlation between carbonyl concentrations in lavage fluid and plasma, and between protein carbonyls, thiobarbituric acid-reactive substances and myeloperoxidase in the lungs. CONCLUSIONS: Our results provide evidence of oxidation occurring early in severe sepsis and major trauma patients, with protein carbonyl measurements providing a sensitive index of this process. High protein carbonyl concentrations in plasma as well as bronchial aspirates indicate that oxidation is not restricted to the lungs. The correlation between oxidative measures and myeloperoxidase concentrations in the lung indicates that neutrophil oxidants could be responsible for the injury.

The effect of selenium supplementation on outcome in very low birth weight infants: a randomized controlled trial. The New Zealand Neonatal Study Group.

BACKGROUND: Low selenium (SE) status has been documented in preterm infants and has been suggested to be a risk factor for chronic lung disease. METHODS: A total of 534 infants with birth weight <1500 g were enrolled in 8 New Zealand centers in a double-blind placebo-controlled randomized trial of SE supplementation from week 1 of life until 36 weeks' postmenstrual age or discharge home. Supplemented infants received 7 microg/kg/d of SE when fed parenterally and 5 microg/kg/d when fed orally. Plasma SE and glutathione peroxidase concentrations were measured in mothers after delivery and in infants before randomization and at 28 days and 36 weeks' postmenstrual age. Primary outcome measures were oxygen dependency at 28 days and total days oxygen dependency. RESULTS: No significant differences were seen between the groups with respect to primary or secondary outcome measures, with the exception that fewer supplemented infants had an episode of sepsis after the first week of life (P <.038). Mean plasma SE concentrations were 0.33 micromol/L before randomization in both groups and at 28 days had risen in the supplemented group (0.56 micromol/L) but fallen in the control group (0.29 micromol/L) (P <.0001). There was no association between outcome measures and SE concentrations at 28 days or 36 weeks' postmenstrual age. However, lower maternal and infant prerandomization SE concentrations were associated with increased respiratory morbidity. CONCLUSIONS: Postnatal SE supplementation in very low birth weight infants did not improve neonatal outcome. Further investigation of SE supplementation of mothers from the second half of pregnancy is warranted.