Why neonates won't survive without venous access and constant glucose.

Message to Dr. Dewi Evans

Jamie Egan

1 min read

First, oxygen desaturation events that frequently occur in the NICU setting, most often because of prematurity or respiratory disease, lead to reduced energy stores in neonates. Neonates experiencing multiple oxygen desaturation events are at risk for hypoxia, which refers to an inadequate oxygen supply to the tissues. This leads to a reduced rate of oxidative phosphorylation by aerobic respiration and to reduced adenosine triphosphate (ATP) synthesis. ATP is the energy currency in human biology. Because of the absence of oxygen as a final electron acceptor, the mitochondria cannot sustain the proton gradient required for ATP formation from adenosine diphosphate (ADP) and inorganic phosphate. This leads to a decrease in ATP production and potential disruption.

Second, stressful stimuli, such as procedural pain, can lead to a reduction in energy stores. We explored the effects of tissue damaging procedures (TDPs) on ATP metabolism. After the removal of a central or venous catheter, we found a significant increase in uric acid (UA) and malondialdehyde (MDA) thirty minutes after the painful stimulus.

UA is a downstream product of ATP degradation. MDA is an oxidative stress marker formed by the oxidative degradation of polyunsaturated lipids by reactive oxygen species (ROS). The increase in ATP degradation in response to painful procedures may be because of energy spent through behavioral and physiological reactions to pain, such as crying, facial grimacing, flailing and tachycardia. Increased purine degradation, accompanied by the production of ROS, could contribute to the observed increase in oxidative stress. Alternatively, increased oxidative stress could also result from the increased activity of mitochondrial ATP synthesis, which produces ROS as a byproduct, in order to meet the energy demands of increased ATP utilization. Both the increased ATP utilization and oxidative stress can lead to energy deficit and energy deficit will lead to increased entropy and death.