Related Experiment Videos
Is routine vitamin E administration justified in very low-birthweight infants?
M R Law1, K Wijewardene, N J Wald
1Department of Environmental and Preventive Medicine, Medical College of St. Bartholomew's Hospital, Charterhouse Square, London.
Insights
Prophylactic vitamin E supplementation did not reduce retinopathy of prematurity in very low-birthweight infants. While it reduced intraventricular hemorrhage, routine use is not justified due to limited benefits and potential toxicity.
Area of Science:
- Neonatal Medicine
- Pediatric Ophthalmology
- Clinical Pharmacology
Background:
- Retinopathy of prematurity (ROP) and intracranial hemorrhage (ICH) are significant concerns in very low-birthweight (VLBW) infants.
- Prophylactic vitamin E has been explored to mitigate these risks.
Purpose of the Study:
- To evaluate the efficacy and safety of prophylactic vitamin E supplementation in VLBW infants.
Main Methods:
- Systematic review and meta-analysis of nine randomized controlled trials.
- Inclusion criteria focused on VLBW infants (<1500g) receiving prophylactic vitamin E.
Main Results:
- No significant reduction in acute retinopathy of prematurity incidence.
- A 49% reduction in intraventricular hemorrhage (IVH) incidence was observed.
- No clear evidence for reduced overall intracerebral hemorrhage or germinal matrix hemorrhage.
- Estimated benefit for VLBW infants is low (point estimate 1.5%, upper bound ~4%).
- Potential toxicity concerns at therapeutic concentrations.
Conclusions:
- Routine prophylactic vitamin E supplementation is not justified in VLBW infants based on current evidence.
- The limited demonstrated benefit and potential risks do not support widespread use.
- Further large-scale randomized trials are needed to definitively assess the risk-benefit profile.
Abstract:
Analysis of nine randomised controlled trials of prophylactic vitamin E supplementation in very low-birthweight infants (less than 1500g) showed no statistically significant reduction in the incidence of acute retinopathy of prematurity. There was a significant reduction (49 per cent) in the incidence of intraventricular haemorrhage, but no clear evidence for a corresponding reduction in intracerebral haemorrhage and no reduction in the incidence of haemorrhage confined to the germinal matrix. By combining the estimated reduction with the known incidence of long-term neurological disability associated with intracranial haemorrhage alone, it was shown that only 1.5 per cent (point estimate) and not more than about 4 per cent of all very low-birthweight infants are likely to benefit from routine vitamin E supplementation. In view of this, and data suggesting toxicity of vitamin E at concentrations close to those considered therapeutic, the routine use of vitamin E in very low-birthweight infants is not justified on present evidence. Only large randomised trials can establish whether currently used vitamin E preparations do more good than harm.