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Protective effect of vitamin E on intraventricular haemorrhage in the newborn
Insights
Vitamin E supplementation may reduce intraventricular hemorrhage in premature infants. While overall rates were similar, vitamin E was linked to lower rates of severe brain bleeds in babies under 32 weeks gestation.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Biochemistry
Background:
- Premature infants are at high risk for brain hemorrhages, particularly intraventricular hemorrhage (IVH).
- Subependymal hemorrhage (SEH) is a precursor to IVH, often occurring in very low birth weight and preterm neonates.
- Oxidative stress is implicated in the pathogenesis of neonatal brain injury.
Purpose of the Study:
- To investigate the efficacy of early vitamin E supplementation in preventing SEH and IVH in low birth weight infants.
- To determine the relationship between plasma vitamin E levels and the occurrence and severity of brain hemorrhages.
Main Methods:
- A randomized controlled trial involving 44 low birth weight infants (<1751 g).
- Infants received daily intramuscular vitamin E (all-rac-alpha-tocopheryl acetate) from birth to Day 3 or were assigned to a control group.
- Cranial ultrasounds were performed during the first week of life to classify hemorrhages as none, SEH only, or IVH.
Main Results:
- The overall incidence of SEH or IVH did not differ significantly between supplemented and control groups (42.9% vs. 43.5%).
- However, in infants <32 weeks gestation, IVH was significantly less common in the vitamin E supplemented group (18.8%) compared to controls (56.3%).
- Infants with IVH had lower median plasma vitamin E concentrations, and the three supplemented infants who developed IVH had the lowest vitamin E levels.
Conclusions:
- Early vitamin E supplementation may reduce the incidence of severe intraventricular hemorrhage in very preterm infants (<32 weeks gestation).
- Vitamin E may protect capillary endothelial cell membranes from oxidative damage, thereby limiting hemorrhage severity.
- Maintaining adequate plasma vitamin E levels appears crucial for its potential neuroprotective effects in vulnerable neonates.
Abstract:
Forty-four consecutively born babies of birth weights under 1751 g were randomly selected to receive a daily intramuscular injection of vitamin E (all-rac-alpha-tocopheryl acetate) from the day of birth (Day 0) until Day 3, or were allocated to a non-supplemented control group. Frequent ultrasound examinations of the brain were made during the first week of life and babies were classified as having 'no haemorrhage', 'subependymal haemorrhage (SEH) only' or 'intraventricular haemorrhage' (IVH). The incidence of SEH or IVH was similar in supplemented (42.9%) and control babies (43.5%). SEH or IVH was observed only in babies of less than 32 weeks gestation; when only babies under 32 weeks were considered, IVH was less common in those supplemented (18.8%) than in the controls (56.3%). Babies with IVH had lower median plasma vitamin E concentrations when compared with babies without any haemorrhage and compared with those with only SEH. Three supplemented babies suffered IVH and they were the three with the lowest plasma vitamin E concentrations among the babies supplemented with vitamin E from Day 0 to Day 3. We speculate that vitamin E protects endothelial cell membranes of capillaries in the subependymal layer of the brain against oxidative damage and disruption and thereby limits the magnitude of haemorrhage in the subependymal layer, and reduces the risk of extension into the ventricles.