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Development of vitamin-E-status of premature infants after intravenous application of all-rac-alpha-tocopheryl
P Schwalbe1, P Büttner, I Elmadfa
1University of Vienna, Institute of Nutrition, Austria.
Insights
Premature infants born weighing 1,500g or less often have low vitamin E. Supplementation with intravenous alpha-tocopherol acetate effectively raised their serum vitamin E levels to normal ranges without complications.
Area of Science:
- Neonatal Nutrition
- Pediatric Endocrinology
- Clinical Biochemistry
Background:
- Premature infants, particularly those with very low birth weight (≤1,500 g), frequently exhibit suboptimal vitamin E status.
- Vitamin E is crucial for neonatal health, playing a role in antioxidant defense and immune function.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous all-rac-alpha-tocopherol acetate supplementation in preterm infants receiving total parenteral nutrition.
- To determine the optimal dosage and administration route for achieving adequate serum alpha-tocopherol concentrations in this vulnerable population.
Main Methods:
- A cohort of premature infants (birth weight ≤1,500 g) received 4.5 mg/kg/day of intravenous all-rac-alpha-tocopherol acetate for five days during parenteral nutrition.
- Control infants received identical parenteral nutrition without vitamin E supplementation.
- Serum alpha-tocopherol levels were quantified using High-Performance Liquid Chromatography (HPLC) on days 1, 3, 7, and 14.
Main Results:
- Initial serum vitamin E levels averaged 0.33 mg/dL.
- Intravenous supplementation led to a significant increase in serum alpha-tocopherol concentrations.
- Serum levels reached 1.00 mg/dL seven days post-supplementation, with a peak of 2.45 mg/dL observed.
- The study demonstrated that the chosen dose and method of administration were effective in normalizing vitamin E levels.
Conclusions:
- Intravenous administration of 4.5 mg/kg/day of all-rac-alpha-tocopherol acetate is a safe and effective strategy for correcting vitamin E deficiency in preterm infants.
- This supplementation regimen successfully achieved and maintained therapeutic serum alpha-tocopherol concentrations without adverse effects.
- The findings support the routine use of this vitamin E supplementation protocol in high-risk premature infants.
Abstract:
A low vitamin-E-status was found in premature infants with birth weight less than or equal to 1,500 g. In this study the plasma vitamin-E-concentration of premature infants was analysed 2-3 h postpartal. During a total parenteral nutrition including fat emulsions the children received 4.5 mg all-rac-alpha-tocopherol acetate/kg/d (approximately 3 mg rrr alpha-tocopherol equivalents/kg/d) intravenously for 5 days. On the same days control-infants received the same fat emulsions without supplemented vitamin E. Serum alpha-tocopherol-levels were analysed on day 1, 3, 7 and 14 by HPLC. Initially the serum vitamin E level was 0.33 mg alpha-tocopherol/dl. Following the intravenous administration there was a significant increase in serum free alpha-tocopherol level. 7 days after end of supplementation the alpha-tocopherol concentration in serum reached 1,000 mg/dl serum. The highest level analysed after tocopheryl acetate supplementation was 2.45 mg alpha-tocopherol/dl. The choosen dose of 4.5 mg all-rac-alpha-tocopheryl acetate/kg body weight/day and this form of application were suitable to achieve normal serum alpha-tocopherol concentrations in premature infants without any complications.