Complete Shielding of Multivitamins to Reduce Toxic Peroxides in the Parenteral Nutrition: A Pilot Study
Condition: Parenteral Nutrition; Infant, Premature, Diseases; Infant, Newborn, Disease; Lung Diseases; Respiratory Tract Disease; Bronchopulmonary Dysplasia; Pathologic Processes
MeSH terms: Lung Diseases; Bronchopulmonary Dysplasia; Respiratory Tract Diseases; Infant, Premature, Diseases; Infant, Newborn, Diseases; Pathologic Processes
Study type: Interventional

Summary: 
      The purpose of this study is to examine if a new and simple method involving complete
      photo-protection of multivitamins only (since sampling through infusion) will result in a
      significant reduction of peroxide contamination of parenteral nutrition compared to standard
      method of parenteral nutrition preparation and infusion in extremely preterm infants.
    

Detailed description: 
      Hypothesis and Objectives:

      The investigators propose, in this pilot study, a new and simple method involving complete
      photo-protection of multivitamins (MV) only (since sampling through infusion) and they
      hypothesize that this method will be readily applicable and will result in a significant
      reduction of peroxide contamination of parenteral nutrition (PN) compared to standard care of
      PN preparation and infusion method.

      In Vitro Results Using This Proposed Photo-Protection Method:

      This method has reduced the quantity of infused peroxides (as equivalent H2O2). When adding
      the generated peroxides over 5 hours (5 samples: at times 0, 30 minutes, 1, 3 and 5 hours),
      the total peroxides were 1270± 47 micromolar (μM) without photo-protection vs. 710±16 μM with
      this method, leading to 45% reduction of peroxides (data presented as a poster presentation
      in the Pediatric academic societies meeting , 2018, Poster number 2874.625). This reduction
      is comparable to the previously reported in vitro data for the whole PN complete
      photo-protection that reported 50% reduction of peroxides.

      Specific objective of this pilot study:

      To examine if this new and simple method will be feasible in clinical practice and will
      result in a significant reduction of urinary peroxide concentration when compared to standard
      PN compounding and infusion technique.

      Innovation:

      The investigators' team's long experience in this field permitted the identification of the
      interaction between light and MV (specifically riboflavin) that leads to doubling the amount
      of peroxides contaminating the PN. The complexity of complete photo-protection encountered by
      the team to conduct small uni-center studies and the incapacity to introduce the complete
      photo-protection in daily clinical practice led the team to create this simple intervention
      that will address the problem at its origin in a practical way. All trials, including
      complete PN photo-protection, faced the complexity of keeping MV away from light while
      needing to prepare the PN admixture under the light of a sterile hood. Added to this was the
      complexity of completely covering the PN bag while compounding the admixture. Light exposure
      may also occur during the transportation of the PN from the hospital pharmacy to the neonatal
      unit (even with special attention to the bottom of the bag and the area around the tubing
      being well covered).

      The proposed intervention will eliminate all these complex procedures by directly sampling
      the MV in a photo-protected syringe, transporting it in this syringe, and directly infusing
      the MV into the photo-protected intravenous lines through its infusion into the patient.
    

Intervention name(s): Photo-protection; Standard Care
Intervention type(s): Other; Other
Intervention description(s): The MV solution is delivered from producing companies in amber vials. The MV will be sampled by the pharmacy technician in a syringe that is photo-protected with a white label indicating the subject study name, protocol number and the infusion rate. The MV will be transported to the unit in the same photo-protected syringe. In the neonatal unit, this syringe will be installed in the pump and connected to photo-protected extension duration.; This group will receive the standard practice of PN compounding in the pharmacy followed by infusion in standard infusion kit available in Sainte-Justine's Hospital.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Photo-protection of Multivitamins; Oxidative Stress; Ascorbyl peroxide; Urine peroxides