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What Is The Appropriate Intravenous Dose Of Vitamin E For Very-Low-Birth-Weight Infants?

Journal of Perinatology volume 24, pages 205–207 (2004)Cite this article

Abstract

The Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) has endorsed 1 to 2 mg/dl as the normal range of serum tocopherol level. Our Cochrane review has shown that vitamin E supplementation resulting in levels >3.5 mg/dl, but not ≤3.5 mg/dl, significantly reduces the risk for severe retinopathy among very-low-birth-weight (VLBW) infants examined but increases the risks of sepsis and of necrotizing enterocolitis among infants treated for >1 week. As a fixed daily intravenous dose of vitamin E results in an inverse relationship between serum level and birth weight and is a risk for both low and high serum tocopherol levels, a dose adjusted for current weight appears more judicious than a fixed dose per day. Based on currently available data the AAP and the American Society for Clinical Nutrition currently recommend a routine intake of 2 ml/kg/day of MVI® Pediatric™ (2.8 IU/kg/day) in VLBW infants (maximum of 5 ml/day or 7 IU/day).

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References

  1. Committee on Nutrition. Nutritional needs of preterm infants. In: William J. Klish, editor. Pediatric Nutrition Handbook 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics; 1998. p. 55–87.

  2. Greene HL, Hambidge M, Schanler R, Tsang RC . Guidelines for the use of vitamins, trace elements, calcium, magnesium, and phosphorus in infants and children receiving total parenteral nutrition: report of the Subcommittee on Pediatric Parenteral Nutrient Requirements from the Committee on Clinical Practice Issues of the American Society for Clinical Nutrition. Am J Clin Nutr 1988;48:1324–1342.

    Article  CAS  Google Scholar 

  3. Gross SJ . Vitamin E. In: Tsang RC, Lucas A, Uauy R, Zlotkin S, editors. Nutritional Needs of the Preterm Infant. Scientific Basis and Practical guidelines. Pawling, NY: Caduceus Medical Publishers, Inc., for Williams & Wilkins; 1993. p. 101–109.

    Google Scholar 

  4. Greer FR . Vitamin metabolism and requirements in the micropremie. Clin Perinatol 2000;27:95–118.

    Article  CAS  Google Scholar 

  5. Committee on Nutrition. Nutritional needs of preterm infants. In: Kleinman RE, editor. Pediatric Nutrition Handbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003. pp. 23–54.

  6. Astra Pharmaceuticals. M.V.I.® Pediatric™ package insert. http://www.mvi-us.com/pdf/newsline_vol6num4.pdf.

  7. Bell EF, Filer Jr LJ . The role of vitamin E in the nutrition of premature infants. Am J Clin Nutr 1981;34:414–422.

    Article  CAS  Google Scholar 

  8. Poland RL . Vitamin E: what should we do? Pediatrics 1986;77:787–788 (letter).

    Google Scholar 

  9. Johnson L, Quinn GE, Abbasi S, Gerdes J, Bowen FW, Bhutani V . Severe retinopathy of prematurity in infants with birth weights less than 1250 grams: incidence and outcome of treatment with pharmacologic serum levels of vitamin E in addition to cryotherapy from 1985 to 1991. J Pediatr 1995;127:632–639.

    Article  CAS  Google Scholar 

  10. Sobel S, Gueriguian J, Troendle G, Nevius E . Vitamin E in retrolental fibroplasia. N Engl J Med 1982;306:867 (letter).

    Google Scholar 

  11. Kanno T, Utsumi T, Takehara Y, et al. Inhibition of neutrophil-superoxide generation by alpha-tocopherol and coenzyme Q. Free Radic Res 1996;24:281–289.

    Article  CAS  Google Scholar 

  12. Corrigan Jr JJ . Coagulation problems relating to vitamin E. Am J Pediatr Hematol Oncol 1979;1:169–173.

    Article  CAS  Google Scholar 

  13. Stuart MJ, Oski FA . Vitamin E and platelet function. Am J Pediatr Hematol Oncol 1979;11:77–82.

    Google Scholar 

  14. Henton DH, Merritt RJ, Hack S . Vitamin E measurement in patients receiving intravenous lipid emulsions. J Parenter Enteral Nutr 1992;16:133–135.

    Article  CAS  Google Scholar 

  15. Friedman CA, Wender DF, Temple DM, Parks BR, Rawson JE . Serum alpha-tocopherol concentrations in preterm infants receiving less than 25 mg/kg/day alpha-tocopherol acetate supplements. Dev Pharmacol Ther 1988;11:273–280.

    Article  CAS  Google Scholar 

  16. Amin SB, Laroia N, Sinkin RA, Kendig JW . Effect of dexamethasone therapy on serum vitamin E concentrations in premature infants with bronchopulmonary dysplasia. J Perinatol 2003;23:552–555.

    Article  CAS  Google Scholar 

  17. Johnson L . Vitamin E nutrition in the fetus and newborn. In: Polin RA, Fox WW, editors. Fetal and Neonatal Physiology 2nd ed. Philadelphia: WB Saunders; 1998, 425–442.

    Google Scholar 

  18. Brion LP, Bell E, Raghuveer T . Vitamin E supplementation for prevention of morbidity and mortality in preterm infants (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.

  19. Amorde-Spalding K, D'Harlingue AE, Phillips BL, et al. Tocopherol levels in infants < or=1000 grams receiving MVI pediatric. Pediatrics 1992;90:992–994.

    CAS  PubMed  Google Scholar 

  20. DeVito V, Reynolds JW, Benda GI, Carlson C . Serum vitamin E levels in very low-birth weight infants receiving vitamin E in parenteral nutrition solutions. J Parenter Enteral Nutr 1986;10:63–65.

    Article  CAS  Google Scholar 

  21. MacDonald MG, Fletcher AB, Johnson EL, Boeckx RL, Getson PR, Miller MK . The potential toxicity to neonates of multivitamin preparations used in parenteral nutrition. J Parenter Enteral Nutr 1987;11:169–171.

    Article  CAS  Google Scholar 

  22. Kerner JA, Poole RL, Sunshine P, Stevenson DK . High Serum vitamin E levels in premature infants receiving MV1-pediatric. J Parenter Enteral Nutr 1987;1:75–82.

    Google Scholar 

  23. Greene HL, Moore C, Phillips B, et al. Evaluation of a pediatric multivitamin preparation for total parenteral nutrition. II. Blood levels of vitamins A, D and E. Pediatrics 1986;77:539–547.

    CAS  PubMed  Google Scholar 

  24. Phillips B, Franck LS, Greene HL . Vitamin E levels in premature infants during and after intravenous multivitamin supplementation. Pediatrics 1987;80:680–683.

    CAS  PubMed  Google Scholar 

  25. Schwalbe P, Buttner P, Elmadfa I . Development of vitamin-E-status of premature infants after intravenous application of all-rac-alpha-tocopheryl acetate. Int J Vitam Nutr Res 1992;62:9–14.

    CAS  PubMed  Google Scholar 

  26. Gutcher GR . Tissue levels of vitamin E (alpha-tocopherol) in response to continuous intravenous multivitamin infusion. J Parenter Enteral Nutr 1988;12:152–154.

    Article  CAS  Google Scholar 

  27. Etches PC, Finer N, Dinwoodie A . MVI pediatric dose for neonates. Pediatr Res 1987;21:360A.

    Google Scholar 

  28. Etches PC, Koo WWK . Parenteral vitamins A, D and E for premature infants. J Perinatol 1988;8:93–95.

    CAS  PubMed  Google Scholar 

  29. Baeckert PA, Greene HL, Fritz I, Oelberg DG, Adcock EW . Vitamin concentrations in very low birth weight infants given vitamins intravenously in a lipid emulsion: measurement of vitamins A, D, and E and riboflavin. J Pediatr 1988;113:1057–1065.

    Article  CAS  Google Scholar 

  30. Darlow BA, Graham PJ . Vitamin A supplementation for preventing morbidity and mortality in very low birthweight infants (Cochrane Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.

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Authors and Affiliations

  1. Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA

    Luc P Brion & Lamia Soghier

  2. University of Iowa, Iowa City, Iowa, USA

    Edward F Bell

  3. University of Kansas Medical Center, Kansas City, KS, USA

    Talkad S Raghuveer

Authors
  1. Luc P Brion
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  2. Edward F Bell
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  3. Talkad S Raghuveer
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  4. Lamia Soghier
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Brion, L., Bell, E., Raghuveer, T. et al. What Is The Appropriate Intravenous Dose Of Vitamin E For Very-Low-Birth-Weight Infants?. J Perinatol 24, 205–207 (2004). https://doi.org/10.1038/sj.jp.7211078

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