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Vitamin E supplementation reduces frequency of periventricular haemorrhage in very preterm babies
Insights
Vitamin E supplementation in premature infants (≤32 weeks gestation) significantly reduced the incidence of brain hemorrhages. This intervention proved effective in preventing periventricular and intraventricular hemorrhages in vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Biochemistry
Background:
- Periventricular-intraventricular hemorrhage (PIVH) is a major complication in preterm infants.
- Current preventative strategies for PIVH have limited efficacy.
- Oxidative stress is implicated in the pathogenesis of PIVH.
Purpose of the Study:
- To evaluate the efficacy of vitamin E (dl-alpha-tocopherol acetate) in preventing periventricular hemorrhage in preterm neonates.
- To assess the impact of vitamin E on plasma vitamin E concentrations and red blood cell stability.
- To determine the effect of vitamin E on mortality and neurological outcomes in survivors.
Main Methods:
- A randomized controlled trial involving 231 infants born at ≤32 weeks gestation.
- Daily intramuscular administration of 20 mg/kg vitamin E during the first 3 days of life.
- Assessment of periventricular hemorrhage using serial ultrasound brain scans.
Main Results:
- Vitamin E supplementation increased plasma vitamin E levels and reduced in vitro red blood cell hemolysis.
- Significantly lower rates of intraventricular hemorrhage (8.8% vs 34.3%) and combined intraventricular/parenchymal hemorrhage (10.8% vs 40.7%) in supplemented infants.
- The protective effect was observed in both inborn and referred infants, with a stronger effect in inborn neonates.
- No significant effect on mortality, but reduced hemorrhage rates among survivors (10.7% vs 32.6%).
Conclusions:
- Early postnatal vitamin E supplementation is effective in preventing periventricular and intraventricular hemorrhages in preterm infants.
- Vitamin E may exert its protective effect by scavenging free radicals and limiting oxidative damage.
- Further research into the optimal dosage and timing of vitamin E administration is warranted.
Abstract:
231 babies, born at less than or equal to 32 weeks' gestation were enrolled in a randomised, controlled trial to assess the efficacy of vitamin E (dl-alpha-tocopherol acetate) in the prevention of periventricular haemorrhage. Daily supplementation with 20 mg/kg vitamin E intramuscularly during the first 3 days of life was associated with a rise in plasma vitamin E concentration and a reduction in hydrogen peroxide haemolysis of red blood cells in vitro. Among babies without haemorrhage on entry to the trial (n = 210), supplemented babies had a lower frequency of intraventricular haemorrhage than controls (8.8% v 34.3%; p less than 0.005) and a lower combined frequency of intraventricular and parenchymal haemorrhage (10.8% v 40.7%; p less than 0.0001) on the final ultrasound brain scan. This protective effect was observed in both inborn and referred babies but was stronger in the former. Supplementation had no effect on mortality, but among survivors fewer supplemented babies than controls had intraventricular or parenchymal haemorrhage (10.7% v 32.6%; p less than 0.001). Possibly, vitamin E scavenges free radicals generated during ischaemic injury of the subependymal region and thereby limits tissue damage and the extent of periventricular haemorrhage on reperfusion.