ANTIOXIDANT ACTIVITY, PACKED CELL TRANSFUSIONS, AND OUTCOME IN PREMATURE-INFANTS

Aim-To evaluate the relative importance of biochemical markers of anti oxidant status, gestational age, and parameters of neonatal care in th e clinical outcome of premature infants. Method-A prospective, observa tional, longitudinal study of the association between these factors wa s conducted. Blood was collected from an in situ arterial line within two hours of birth and at intervals thereafter; when blood was drawn f or routine clinical purposes. Outcome was assessed as death, or surviv al with or without bronchopulmonary dysplasia (BPD), One hundred and f orty four babies of 22 to 39 weeks of gestation, who required intensiv e care at the Jessop Hospital for Women, between January 1993 and Apri l 1994, were recruited. Results-Low gestational age at birth was the m ost important predictor of mortality and the development of BPD. Havin g corrected for gestational age, low plasma antioxidant activity at bi rth was an independent risk factor for mortality. Plasma vitamin C at birth was significantly higher in the babies who died compared with th ose with a good outcome, but this effect was not sustained after corre cting for gestational age. Repeated measures of Analysis of Variance r evealed a postnatal increase in antioxidant activity, caeruloplasmin, retinol, cholesterol corrected a tocopherol, and red blood cell supero xide dismutase (SOD) activity. Vitamin C, on the other hand, declined in all groups after birth. Logistic regression analysis revealed that the greater the number of packed cell transfusions received during int ensive cart, and the higher the concentration of vitamin C on the seco nd day of life, the greater the risk of developing BPD. Conclusions-Af ter correcting for the effect of gestational age, low plasma antioxida nt activity at birth was an independent risk factor for mortality. Fre quent blood cell transfusions over the first week of life are associat ed with an increased risk of developing BPD. This association may be c ausal.