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Published on: November 11, 2014

Variability in the dose of intravenous vitamin E given to very low birth weight infants

Luc P Brion1, Edward F Bell, Talkad S Raghuveer

  • 1Albert Einstein College of Medicine (L.P.B.), Children's Hospital at Montefiore, Bronx, NY 10461-2373, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|November 19, 2004
PubMed

Insights

Intravenous vitamin E dosing varied widely in US neonatal intensive care units (NICUs) in 2003. Premature infants under 1.0 kg often received excessive, potentially toxic vitamin E doses, highlighting a critical need for standardized protocols.

Area of Science:

  • Neonatology
  • Pediatric Nutrition
  • Clinical Pharmacy

Background:

  • Vitamin E is crucial for very low birth weight (VLBW) infants to prevent deficiency.
  • However, excessive intravenous vitamin E (>4 IU/kg/day) can lead to toxic serum tocopherol levels.
  • Current dosing practices for VLBW infants require assessment.

Purpose of the Study:

  • To evaluate the frequency of inadequate or excessive intravenous vitamin E doses in parenteral nutrition for VLBW infants in the US.
  • To identify variations in vitamin E administration across neonatal units.

Main Methods:

  • A questionnaire was distributed to 100 neonatal-perinatal training centers in the US.
  • Vitamin E doses were calculated for infants weighing 0.5, 1.0, and 1.5 kg.
  • Doses were classified as inadequate (<2.8 IU/kg/day) or excessive (>4 IU/kg/day) and compared using chi-squared analysis.

Main Results:

  • Sixty-five centers responded, primarily high-level neonatal intensive care units (NICUs).
  • Median vitamin E dose was 2.8 IU/kg/day across all infant weights.
  • Inadequate doses were given in 12-19% of NICUs, while excessive doses (>4 IU/kg/day) were administered in 10-40%, with smaller infants (<1.0 kg) receiving higher rates of excessive dosing (p=0.0008).

Conclusions:

  • Significant variability exists in intravenous vitamin E dosing for VLBW infants in US NICUs.
  • The smallest VLBW infants (<1.0 kg) were frequently administered excessive and potentially toxic doses of vitamin E.
  • This highlights a critical need for standardized vitamin E dosing guidelines in neonatal care.
Abstract

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