Download PDF
Am J Perinatol 2003; 20(2): 097-108
DOI: 10.1055/s-2003-38315
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4693

Role of Antioxidant Nutrients and Lipid Peroxidation in Premature Infants with Respiratory Distress Syndrome and Bronchopulmonary Dysplasia

Horacio S. Falciglia1 , J. Robert Johnson2 , JoAnn Sullivan3 , Charles F. Hall2 , Jeffery D. Miller2 , George C. Riechmann2 , Grace A. Falciglia4
  • 1Department of Pediatrics, Division of Neonatology and Pulmonary Biology, Children's Hospital, Cincinnati, Ohio
  • 2Department of Medical Research, Good Samaritan Hospital, Cincinnati, Ohio
  • 3Department of Nursing, Good Samaritan Hospital, Cincinnati, Ohio
  • 4Department of Nutrition, College of Allied Health Sciences, University of Cincinnati, Ohio
Further Information

Publication History

Publication Date:
27 March 2003 (online)

    Permissions and Reprints

ABSTRACT

The objective of this study was to determine if newborn premature infants with severe respiratory distress syndrome (RDS) who developed bronchopulmonary dysplasia (BPD) demonstrate, within the first 3 days of life, lower blood levels of antioxidants and higher urine levels of lipid peroxidation products than premature infants who recovered from RDS. Perinatal variables (gestational age, birth weight, and Apgar scores) and antioxidant indices in cord and in third day of life plasma and red blood cell (RBC) samples from healthy premature infants (n = 35), infants with RDS (n = 23) and infants with BPD (n = 23) were examined. Antioxidant indices included selenium, alpha-tocopherol, total and oxidized glutathione, glutathione peroxidase, superoxide dismutase, and urinary malondialdehyde. By inferential statistics, only the perinatal variables and cord plasma selenium distinguished healthy premature infants from premature infants with RDS or BPD. From perinatal variables and antioxidant indices we calculated: (1) cord to third-day-of-life variable differences, (2) variable-to-variable ratios, and (3) ratios of a difference for one variable to a difference for any second variable. Subset regression analysis yielded an equation (adjusted R

@affil2:2 = 0.8839) that correctly predicted infants who developed BPD 100% of the time. Predictor variables for BPD were gestational age, Apgar at 1 min, cord and third-day-of-life RBC selenium, cord total glutathione, cord and third-day-of-life glutathione peroxidase and nine different ratios involving Apgar scores, RBC selenium, total and oxidized glutathione, alpha-tocopherol, glutathione peroxidase, and superoxide dismutase. In this study, there was no relationship between lipid peroxidation and BPD. There was a higher rate of patent ductus arteriosus, congestive heart failure, and retinopathy of prematurity in infants with BPD. This study confirms that low plasma selenium and alpha-tocopherol levels in premature infants (≤ 30 weeks' gestational age or lower) were significantly associated with an increased respiratory morbidity.

KEYWORDS

Antioxidants - respiratory distress syndrome - bronchopulmonary dysplasia

REFERENCES

  • 1 Edwards D K, Dyer W M, Northway Jr H W. Twelve years experience with bronchopulmonary dysplasia.  Pediatrics . 1977;  59 839-846
    PubMedGoogle Scholar
  • 2 Pusey V A, MacPherson R I, Chernick V. Pulmonary fibroplasia following prolonged artificial ventilation of newborn infants.  Can Med Assoc J . 1969;  100 451-457
    PubMedGoogle Scholar
  • 3 Watts J L, Ariagno R L, Brady J P. Chronic pulmonary disease in neonates after artificial ventilation: distribution of ventilation and pulmonary interstitial emphysema.  Pediatrics . 1977;  60 273-281
    PubMedGoogle Scholar
  • 4 Frank L, Sosenko I R. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia.  Am Rev Respir Dis . 1988;  138 725-729
    PubMedGoogle Scholar
  • 5 Brown E R, Stark A, Sosenko I R, Lawson E E, Avery M E. Bronchopulmonary dysplasia: possible relationships to pulmonary edema.  J Pediatr . 1978;  92 982-984
    CrossrefPubMedGoogle Scholar
  • 6 Shenai J P, Chytil F, Stahlman M T. Vitamin A status of neonates with bronchopulmonary dysplasia.  Pediatr Res . 1985;  19 185-189
    CrossrefPubMedGoogle Scholar
  • 7 Rotruck J T, Pope A L, Ganther H E, Swanson A B, Hafeman D G, Hoekstra W G. Selenium: biochemical role as a component of glutathione peroxidase.  Science . 1973;  179 588-590
    CrossrefPubMedGoogle Scholar
  • 8 Cruz M L, Bhadra S, Subbiah M T, Tsang R C. Serum lipid peroxidation potential in infants.  Arch Pediatr Adolesc Med . 1994;  148 1212-1215
    PubMedGoogle Scholar
  • 9 Falciglia H S, Ginn-Pease M E, Falciglia G A, Lubin A H, Frank D J, Chang W. Vitamin E and selenium levels of premature infants with severe respiratory distress syndrome and bronchopulmonary dysplasia.  J Pediatr Perinat Nutr . 1988;  2 35-49
    PubMedGoogle Scholar
  • 10 Ballard J L, Khory J C, Wedig K, Wang L, Eilers-Walsman B L, Lipp R. New Ballard Score, expanded to include extremely premature infants.  J Pediatr . 1991;  119 417-423
    CrossrefPubMedGoogle Scholar
  • 11 Amin S, Chen S Y, Collip P J, Castro-Magana M, Maddaiah V T, Klein S W. Selenium in premature infants.  Nutr Metab . 1980;  24 331-340
    PubMedGoogle Scholar
  • 12 Mino M, Kitagawa M, Nakagawa S. Red blood cell tocopherol concentrations in a normal population of Japanese children and premature infants in relation to the assessment of vitamin E status.  Am J Clin Nutr . 1985;  41 631-638
    PubMedGoogle Scholar
  • 13 Anderson M E. Determination of glutathione and glutathione disulfide in biological samples.  Methods Enzymol . 1985;  113 548-555
    PubMedGoogle Scholar
  • 14 Yoshioka T, Sugiue A, Shimada T, Utsumi K Superoxide dismutase activity in the maternal and cord blood. Biol Neonate .  1979;  36 173-180
    PubMedGoogle Scholar
  • 15 Flohe L, Gunzler W A. Assays of glutathione peroxidase.  Methods Enzymol . 1984;  105 114-121
    PubMedGoogle Scholar
  • 16 Total Hemoglobin, Quantitative, Colorimetric Determination In Whole Blood at 530-550 nm Sigma Diagnostics Procedure No. 525, pp. 1-6. St. Louis: Sigma Diagnostics. 1984
    Google Scholar
  • 17 Draper H H, Polensek L, Hadley M, McGirr L G. Urinary malondialdehyde as an indicator of lipid peroxidation in the diet and in the tissues.  Lipids . 1984;  19 836-843
    PubMedGoogle Scholar
  • 18 Marshall D D, Kotelchuck M, Young T E, Bose C L, Kruyer L, O'Shea T M. Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologist Association.  Pediatrics . 1999;  104 1345-1350
    CrossrefPubMedGoogle Scholar
  • 19 Committee of Dietary Allowances, Food and Nutrition Board Recommended dietary allowances. Washington, D.C.: National Academy of Sciences 1980
    Google Scholar
  • 20 Combs G F, Noguchi T, Scott L M. Mechanisms of action of selenium and vitamin E in protection of biological membranes.  Fed Proc . 1975;  34 2090-2095
    PubMedGoogle Scholar
  • 21 Tappel A L. Vitamin E and free radical peroxidation of lipids.  Ann NY Acad Sci . 1980;  355 12-44
    PubMedGoogle Scholar
  • 22 Stadtman T C. Selenium-dependent enzymes.  Ann Rev Biochem . 1980;  49 93-110
    PubMedGoogle Scholar
  • 23 Ganther H E, Hafeman D G, Lawrence R A, Serfuss R E, Hoekstra W G. Selenium and glutathione peroxidase in health and disease. A review In: Prasad AS, ed. Trace Elements in Human Health and Disease Vol. 2. New York: Academic Press 1976: 165-233
    Google Scholar
  • 24 Groh J L, Gropper S S. Advanced Nutrition and Human Metabolism, Third Edition (2000) Wadsworth Publishers, Belmont, California. 
    Google Scholar
  • 25 Huston R K, Benda G I, Carlson C V, Shearer T R, Reynolds J W, Neerhout R C. Selenium and vitamin E sufficiency in premature infants requiring total parenteral nutrition.  J Pharm Nutr . 1982;  6 507-510
    PubMedGoogle Scholar
  • 26 Darlow B A, Inder T E, Graham P J, Sluis K B, Malpas T J, Taylor B J. et al . The relationship of selenium status to respiratory outcome in the very low birth weight infant.  Pediatrics . 1995;  96 314-319
    PubMedGoogle Scholar
  • 27 Frank L, Sosenko I R. Undernutition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia.  Am Rev Respir Dis . 1988;  138 725-729
    PubMedGoogle Scholar
  • 28 Widdowson E M, Chan H, Harrison G E, Milner R DG. Accumulation of cu, zn, mn, cr and co in the human liver before birth.  Biol Neonate . 1972;  20 360
    PubMedGoogle Scholar
  • 29 Meehan M A, Falciglia H S, Falciglia G A, Specker B L. Dietary intake of antioxidants during pregnancy and their relationship to bronchopulmonary dysplasia.  Pediatric Res . 1992;  31 1882
    PubMedGoogle Scholar
  • 30 Darlow B A, Winterbourne C C, Inder T E, Graham P J, Harding J E, Weston P J. et al . The effect of selenium supplementation on outcome in very low birth weight infants: a randomized controlled trial. The New Zealand Neonatal Study Group.  J Pediatr . 2000;  136 473-480
    CrossrefPubMedGoogle Scholar
  • 31 Gutcher G R, Raynor W J, Farrell P M. An evaluation of vitamin status in premature infants.  Am J Clin Nutr . 1984;  40 1078-1089
    PubMedGoogle Scholar
  • 32 Desai I D, Martinez F E, Dos Santos E J, Dutra de Oliveria E J. Transient lipoprotein deficiency at birth: a cause of low levels of vitamin E in the newborn.  Acta Vitaminol Enzymol . 1984;  6 71-76
    PubMedGoogle Scholar
  • 33 Fischer W C, Whanger P D. Effects of selenium deficiency on vitamin E metabolism in rats.  J Nutr Sci Vitaminol . 1977;  23 273-280
    PubMedGoogle Scholar
  • 34 Hill K E, Burk R F. Influence of vitamin E and selenium on GSH dependant protection against microsomal lipid peroxidation.  Hepatology . 1982;  2 678
    PubMedGoogle Scholar
  • 35 Ehrenkranz R A, Bonta B W, Ablow R C, Warshaw J B. Amelioration of bronchopulmonary dysplasia after vitamin E administration.  N Engl J Med . 1978;  299 564-569
    PubMedGoogle Scholar
  • 36 Ehrenbranz R A, Ablow R C, Warsaw J B. Effect of vitamin E on the development of oxygen induced lung injury in neonates.  Ann NY Acad Sci . 1982;  393 452-465
    PubMedGoogle Scholar
  • 37 Watts J L, Milner R, Zipursky B, Paes B, Ling E, Gill G, Fletcher B. et al . Failure of supplementation with vitamin E to prevent bronchopulmonary dysplasia in infants <1,500 g birth weight.  Eur Respir J . 1991;  4 188-190
    PubMedGoogle Scholar
  • 38 Berger T M, Frei B, Frei N, Avery M E, Suh J, Yoder B A, Coalson J J. Early high dose antioxidant vitamins do not prevent bronchopulmonary dysplasia in premature baboons exposed to prolonged hyperoxia: a pilot study.  Pediatr Res . 1998;  43 719-726
    PubMedGoogle Scholar
      >