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Serum vitamin E levels in the very low birth weight infant during oral supplementation
Insights
Monitoring serum tocopherol levels in premature infants receiving vitamin E supplementation shows varied results. Many infants maintain adequate vitamin E (tocopherol) levels even after supplementation stops or with reduced dosages.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Clinical Chemistry
Background:
- Premature infants (<1,500g) often require vitamin E supplementation.
- Maintaining adequate serum tocopherol levels is crucial for these vulnerable infants.
- Standard supplementation protocols aim for specific target levels.
Purpose of the Study:
- To monitor serum tocopherol levels in very low birth weight infants receiving oral vitamin E.
- To assess the variability and achievement of target serum tocopherol concentrations.
- To evaluate the impact of dosage adjustments on serum tocopherol levels.
Main Methods:
- Prospective study monitoring serum tocopherol in infants (<1,500g birth weight).
- Routine oral vitamin E (tocopherol acetate) administration at 100 mg/kg/d.
- Weekly/semiweekly serum level determination using a modified fluorometric method.
- Dosage adjustments to maintain levels ≥3.5 mg/dL.
Main Results:
- 567 serum measurements from 76 infants were analyzed.
- 38% of levels were ≥3.5 mg/dL, 13% were ≥5.5 mg/dL, and 2.7% were >8 mg/dL.
- Serum tocopherol often remained elevated after supplementation cessation or with reduced doses (25-50 mg/kg/d).
Conclusions:
- Oral vitamin E supplementation at 100 mg/kg/d results in varied serum tocopherol levels in infants <1,500g.
- A significant percentage of these infants achieve levels exceeding 3.5 mg/dL.
- Infants may maintain adequate levels with reduced vitamin E dosages or after discontinuation.
Abstract:
A prospective study was initiated to monitor serum tocopherol levels in all infants admitted to Indiana University Medical Center with birth weights less than 1,500 g. These infants routinely receive 100 mg/kg/d of oral vitamin E (Aquasol E tocopherol acetate) every six hours. Levels are determined weekly or semiweekly using a modification of the fluorometric method of Hanson and Warwick. Vitamin E dosage is adjusted regularly to achieve levels greater than or equal to 3.5 mg/dL. During the 6 months of this study, a total of 76 patients had 567 serum measurements. Of these, 220 levels (38%) were greater than or equal to 3.5 mg/dL, 71 (13%) were greater than or equal to 5.5 mg/dL, and 15 (2.7%) were greater than 8 mg/dL. Serum tocopherol levels often (1) remained greater than or equal to 3.5 mg/dL for several days after oral supplementation was discontinued or (2) again became greater than or equal to 3.5 mg/dL on a reduced dosage of 25 to 50 mg/kg/d. These data indicate that infants weighing less than 1,500 g at birth who are receiving oral vitamin E supplementation at 100 mg/kg/d will have varied serum levels with a significant percentage exceeding 3.5 mg/dL.