Related Experiment Video
Updated: Aug 19, 2026
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Serum vitamin A and E concentrations in pediatric total parenteral nutrition patients
S L Hack1, R J Merritt, R M Morgan
1Department of Pediatrics, Childrens Hospital of Los Angeles, School of Medicine, University of Southern California.
Insights
Pediatric total parenteral nutrition (TPN) patients showed normal vitamin A levels but lower vitamin E levels compared to controls. Infants on TPN had significantly lower vitamin A than older children.
Area of Science:
- Pediatric Nutrition
- Clinical Chemistry
- Vitamins
Background:
- Optimal fat-soluble vitamin dosing for pediatric total parenteral nutrition (TPN) remains unclear.
- TPN patients often have minimal oral intake, necessitating careful parenteral vitamin supplementation.
- Vitamin A and E status in pediatric TPN requires further investigation.
Purpose of the Study:
- To compare serum vitamin A and E concentrations in pediatric TPN patients with healthy controls.
- To evaluate the adequacy of current vitamin A and E dosing in pediatric TPN.
Main Methods:
- Serum vitamin A and E levels were measured using High-Performance Liquid Chromatography (HPLC).
- TPN patients (1 month-12 years) with chronic TPN (>2 weeks) were compared to age-matched outpatient surgery controls.
- TPN patients received specific doses of vitamin A (retinol) and vitamin E (alpha-tocopheryl acetate).
Main Results:
- Mean serum vitamin A levels were similar between TPN patients and controls.
- TPN patients exhibited significantly lower mean serum vitamin E levels compared to controls.
- Infants on TPN had significantly lower serum vitamin A levels than older TPN patients.
- A higher percentage of TPN patients had low serum vitamin A levels compared to controls.
Conclusions:
- Current vitamin A dosing in pediatric TPN appears adequate, though some infants may have lower levels.
- Vitamin E dosing in pediatric TPN may be insufficient, warranting further investigation.
- Individualized vitamin monitoring is crucial for pediatric TPN patients.
Abstract:
There is uncertainty as to optimal doses of fat soluble vitamins required by pediatric total parenteral nutrition (TPN) patients. We compared serum vitamin A (A) and E (E) concentrations analyzed by HPLC in chronic (greater than 2 weeks) TPN patients aged 1 month to 12 years to values obtained in out-patient surgery patients of the same age. TPN patients received 1500 micrograms of retinol and 2.5 IU of E as alpha-tocopheryl acetate (2.5 ml LyphoMed Multi Vitamin Concentrate). These doses were 214% of the recommended dose of A and 36% for E. Oral intake was minimal in most patients. The results of our study revealed a mean serum A level for TPN patients (N = 29) of 26.0 +/- 15.0 (SD) micrograms/dl vs 25.0 +/- 10.0 (SD) micrograms/dl in controls (N = 52). Mean serum E was 0.63 +/- 0.24 (SD) mg/dl vs 0.89 +/- 0.31 (SD) mg/dl for TPN patients and controls, respectively. There was no consistent trend related to duration of TPN for 23 patients with serial values. Seven (24%) TPN patients had serum A greater than mean + 2 SD of control (p less than 0.01). No values were less than mean - 2 SD. Infants on TPN had a significantly lower mean serum A (22.3 +/- 10.9 micrograms/dl) than TPN patients greater than 1 year of age (34.1 +/- 16.0 micrograms/dl; p less than 0.001). Fifty-two percent of TPN patients vs 26% of control had serum A less than 20 micrograms/dl (p greater than 0.1). For E, one patient had a high value and two patients low values relative to control.(ABSTRACT TRUNCATED AT 250 WORDS)