Glutathione Supplementation in Parenteral Nutrition to Prevent Oxidative Stress Related Complications in Preterm Infants: A Narrative Review of Preclinical Efficacy and Safety Profile.

Numerous adverse effects caused by oxidative stress are commonly observed in preterm infants. This stress is caused by the oxidative burden resulting mainly from supplemental oxygen and parenteral nutrition (PN), and by their precarious antioxidant defense. The natural antioxidant defense against these oxidant molecules relies on glutathione, levels of which are low in preterm infants. Given that several short- and long-term biological complications are associated with this oxidative stress, the aim of this narrative review was to discuss glutathione supplementation as a method for reducing it. Consequently, after briefly discussing the effectiveness of partially reducing oxidative stress through adequate photoprotection of PN, it is proposed to correct premature infants' glutathione deficiency by adding glutathione to PN. To justify the proposed intervention, this article will discuss the scientific evidence related to the (1) importance of glutathione, (2) causes of glutathione deficiency and ways to prevent it, (3) reasons why the disulfide form (GSSG) is recommended over the reduced form (GSH) for PN supplementation, (4) efficacy of parenteral GSSG in preventing oxidative stress, and (5) safety profile of glutathione infusion. In conclusion, we believe that the time has come to improve the health of premature infants by providing GSSG-supplemented PN.