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Vitamin C supplementation in very preterm infants: a randomised controlled trial
1Department of Paediatrics, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand. brian.darlow@chmeds.ac.nz
Insights
Regulating vitamin C (ascorbic acid) in premature infants did not show significant clinical benefits or harm. Higher ascorbic acid levels before randomization were linked to increased mortality risk in this trial.
Area of Science:
- Neonatal medicine
- Nutritional science
- Clinical research
Background:
- Premature infants often have altered vitamin C (ascorbic acid) metabolism.
- Optimal ascorbic acid levels for neonatal outcomes are not well-established.
- Vitamin C supplementation is common in neonatal intensive care units.
Purpose of the Study:
- To investigate the association between plasma ascorbic acid concentrations and clinical outcomes in preterm infants.
- To compare the effects of different ascorbic acid supplementation protocols on neonatal outcomes.
Main Methods:
- A double-blind, randomized controlled trial was conducted in a neonatal intensive care unit.
- Infants with birth weight <1500 g or gestation <32 weeks were randomized into three ascorbic acid supplementation groups (low-low, low-high, high-high) for 28 days.
- Primary outcomes included oxygen requirement and retinopathy of prematurity; plasma ascorbic acid levels were monitored.
Main Results:
- Higher plasma ascorbic acid concentrations before randomization were significantly associated with increased mortality.
- No significant differences in primary outcomes (oxygen requirement, retinopathy of prematurity) were observed between the supplementation groups.
- A trend suggested fewer infants in the high-high ascorbic acid group required oxygen at 36 weeks postmenstrual age compared to the low-low group.
Conclusions:
- Treatment allocation to higher or lower ascorbic acid supplementation did not demonstrate significant benefits or harmful effects in the first 28 days of life.
- Higher initial plasma ascorbic acid levels were a marker for increased mortality risk.
- Further research may be needed to clarify the role of ascorbic acid in specific neonatal populations.
Objective:
To determine whether regulating vitamin C (ascorbic acid: AA) intake to achieve higher or lower plasma concentrations was associated with improved clinical outcome.
Design:
A double blind, randomised controlled trial.
Setting:
Neonatal intensive care unit at Christchurch Women's Hospital.
Patients:
Infants with birth weight <1500 g or gestation <32 weeks, admitted to the unit within 48 hours of birth.
Intervention:
Infants were randomised to one of three protocols with regard to AA supplementation for the first 28 days of life: group LL received low supplementation throughout; group LH received low until day 10 and then high: group HH received high throughout.
Main Outcome Measures:
Primary outcome measures were oxygen requirement at 28 days and 36 weeks postmenstrual age, total days supplemental oxygen, and retinopathy of prematurity. AA concentrations were measured at study entry (day 2), and days 10, 21, and 28.
Results:
A total of 119 infants were enrolled over 24 months (mean gestation 28.4 weeks; birth weight 1161 g). Six infants died, and these had significantly higher AA concentrations before randomisation than surviving infants (116 micromol/l (95% confidence interval 90 to 142) v 51 micromol/l (45 to 58), p<0.0001). There were no significant differences in primary outcomes between the groups. However, the proportion of surviving infants with an oxygen requirement at 36 weeks postmenstrual age in group HH (19%) was half that in group LL (41%) (p=0.06).
Conclusions:
In a randomised controlled trial, no significant benefits or harmful effects were associated with treatment allocation to higher or lower AA supplementation throughout the first 28 days of life.
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