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Vitamin E and retrolental fibroplasia: prevention of serious ocular sequelae
Insights
Early vitamin E supplementation for premature infants (less than 1500g) significantly reduces cicatricial retrolental fibroplasia (RLF). Infants receiving vitamin E within 12 hours had lower RLF rates and severity, suggesting a protective role.
Area of Science:
- Neonatal Ophthalmology
- Pediatric Nutrition
- Critical Care Medicine
Background:
- Retinopathy of prematurity (ROP), formerly retrolental fibroplasia (RLF), is a leading cause of blindness in premature infants.
- The role of vitamin E in preventing RLF has been debated, with varying results in previous studies.
Purpose of the Study:
- To investigate the efficacy of early vitamin E administration in preventing cicatricial RLF in very low birth weight infants.
- To identify factors associated with the development of cicatricial RLF.
Main Methods:
- A cohort of 191 infants weighing less than 1500g were studied.
- Infants received or did not receive early vitamin E supplementation (within 12 hours of birth).
- Incidence of acute and cicatricial RLF, blindness, and necrotizing enterocolitis were recorded. Multiple regression analysis identified risk factors.
Main Results:
- The incidence of cicatricial RLF was significantly lower in infants receiving early vitamin E (3/105) compared to those who did not (13/86).
- Severe cicatricial RLF (Grade III or greater) was absent in the vitamin E group versus 7/86 in the control group.
- Lack of early vitamin E, high arterial PO2 levels, and intraventricular hemorrhage were significant predictors of cicatricial RLF.
Conclusions:
- Early vitamin E supplementation (within 12 hours) is recommended for all infants under 1500g birth weight requiring supplemental oxygen to reduce RLF.
- Vitamin E did not affect the incidence or severity of necrotizing enterocolitis.
- Further research into optimal dosing and timing of vitamin E is warranted.
Abstract:
In an attempt to determine the role of vitamin E in retrolental fibroplasia (RLF) we report our experience with 191 infants of less than 1500 g birth weight. Of these infants, 16.75% had evidence of acute RLF in hospital, 8.4% had cicatricial RLF at follow-up, and four infants (2.1%) were blind, none of whom had received supplementary vitamin E. The incidence of cicatricial RLF at follow-up was significantly lower in infants who received vitamin E early after birth (12 h) than in those who did not (3 of 105 versus 13 of 86, X2 = 9.26, P = 0.002), as was the incidence of Grade III or greater cicatrix (0 of 105 versus 7 of 86, X2 with Yates = 6.72, P = 0.01). Stepwise multiple linear regression analysis revealed three factors distinguishing infants who developed cicatricial RLF from those who did not: the lack of early vitamin E supplements (P = 0.0023), the significantly larger number of arterial PO2 values over 100 mmHg (P = 0.0056), and the presence of an intraventricular haemorrhage (P = 0.0032). The incidence and severity of necrotizing enterocolitis was similar in infants who received vitamin E and in those who did not. It is recommended that vitamin E be given within the first 12 hours of birth to all infants of less than 1500 g who require supplementary oxygen.