Preventing Vitamin E Deficiency in Preterm Infants
Preterm birth affects around 10% of all births in the world, according to the World Health Organisation, and is a large contributor to poor infant-related outcomes. Not only are newborns at increased risk of illness because they have not had enough time to develop fully before they are born, the third trimester of pregnancy is also a time during which the greatest proportion of nutrients such as calcium, iron essential fats and the fat-soluble vitamins are transferred to the fetus. Vitamin E is one of those nutrients that is found in low levels in preterm infants (see review by Debier). Biesalski explains the importance of providing supplemental vitamin E to preterm infants to correct this deficiency. Adequate levels may help to reduce rates of anemia, intracranial hemorrhage and the retinopathy of prematurity. In the journal Pediatrics, Bell and colleagues report on a randomized clinical trial of a single dose of vitamin E to improve vitamin E levels.
The authors supplemented 88 infants under 27 weeks gestation and less than 1 kilogram with 50 IU per kilogram of alpha-tocopherol within four hours of birth via a feeding tube. While this dose is higher than the Adequate intake for newborns of 6 IU, it is not excessively high. An upper limit for vitamin E supplementation for infants has not yet been established, however the tolerable upper limit for toddlers aged 1 to 3 is 300 IU for chronic intakes, so it is likely that a single dose of 50 IU per kilogram is within a safe range for a single dose. A feeding tube has been identified as being the best way to supply vitamin E to newborns. A single dose was successful in increasing vitamin E levels at both 24 hours after birth, and 7 days. The rate of deficiency at 24 hours after birth in the supplemented group was half that of the placebo group.
This study provides initial efficacy, safety and tolerability data on improving nutrient levels and preventing disease related to prematurity in preterm infants. This study was conducted in order to establish a safety profile, and the authors report that based on these results, a larger study will be designed to test whether vitamin E provided to preterm infants is helpful in improving outcomes for these babies that were born too early.
Bell EF, Hansen NI, Brion LP, et al. Serum Tocopherol Levels in Very Preterm Infants After a Single Dose of Vitamin E at Birth. Pediatrics 2013. doi: 10.1542/peds.2013-1684. doi: 10.1542/peds.2013-1684
Arnon S, Regev RH, Bauer S, Shainkin-Kestenbaum R, Shiff Y, Bental Y, Dolfin T, Litmanovitz I. Vitamin E levels during early iron supplementation in preterm infants. Am J Perinatol. 2009 May;26(5):387-92. doi: 10.1055/s-0029-1214233. Epub 2009 Mar 4. http://www.ncbi.nlm.nih.gov/pubmed/19263337
Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, Rubens C, Menon R, Van Look PF. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010 Jan;88(1):31-8. doi: 10.2471/BLT.08.062554. Epub 2009 Sep 25. http://www.ncbi.nlm.nih.gov/pubmed/20428351
Biesalski HK. Vitamin E requirements in parenteral nutrition. Gastroenterology. 2009 Nov;137(5 Suppl):S92-104. doi: 10.1053/j.gastro.2009.07.073. http://www.ncbi.nlm.nih.gov/pubmed/19874955
Brion LP, Bell EF, Raghuveer TS. Vitamin E supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2003;(4):CD003665. http://www.ncbi.nlm.nih.gov/pubmed/14583988
Debier C. Vitamin E during pre- and postnatal periods. Vitam Horm. 2007;76:357-73. http://www.ncbi.nlm.nih.gov/pubmed/17628181
Raghuveer TS, Bloom BT. A paradigm shift in the prevention of retinopathy of prematurity. Neonatology. 2011;100(2):116-29. doi: 10.1159/000322848. Epub 2011 Mar 2. http://www.ncbi.nlm.nih.gov/pubmed/21372594