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Protective effect of vitamin E (DL-alpha-tocopherol) against intraventricular haemorrhage in premature babies
Insights
Vitamin E supplementation in premature infants significantly reduced the incidence of intraventricular hemorrhage. This antioxidant may protect against brain bleeds in vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Biochemistry
Background:
- Premature infants, especially those born before 32 weeks' gestation, are at high risk for intraventricular hemorrhage (IVH).
- Oxidative stress is implicated in the pathogenesis of IVH in neonates.
- Vitamin E, a potent antioxidant, has been investigated for its potential neuroprotective effects in this population.
Purpose of the Study:
- To investigate the efficacy of vitamin E (DL-alpha-tocopherol acetate) supplementation in reducing the incidence and severity of intraventricular hemorrhage in premature infants.
- To assess the relationship between plasma vitamin E concentrations and the occurrence of IVH.
Main Methods:
- A randomized controlled trial involving 44 infants with less than 32 weeks' gestation.
- Infants received either intramuscular vitamin E (25 mg/kg) on days 0, 1, 2, and 3 or served as controls.
- Frequent real-time ultrasound examinations of the brain were performed to monitor for IVH.
Main Results:
- The incidence of IVH was significantly lower in the vitamin E supplemented group (18.8%) compared to the control group (56.3%).
- Babies with IVH had lower median plasma vitamin E concentrations on days 0 and 1 compared to those without hemorrhage.
- Lower vitamin E levels were also observed in infants with IVH compared to those with only subependymal hemorrhage.
Conclusions:
- Vitamin E supplementation appears to be effective in reducing the incidence of intraventricular hemorrhage in premature infants.
- The antioxidant properties of vitamin E may protect endothelial cell membranes from oxidative damage, thereby limiting hemorrhage.
- Maintaining adequate vitamin E levels is crucial for preventing the spread of IVH in neonates.
Abstract:
Forty four babies, of less than 32 weeks' gestation, were either randomly given 25 mg/kg vitamin E (DL-alpha-tocopherol acetate) intramuscularly after birth (day 0) and on days 1, 2, and 3 or served as controls. Frequent real time ultrasound examinations of the brain were made in each baby during the first week and less frequently thereafter. In babies under 32 weeks' gestation the incidence of intraventricular haemorrhage was lower in supplemented babies (18.8%) compared with the controls (56.3%). On days 0, 1, 2, and 3 median plasma vitamin E concentrations in babies without haemorrhage and in those with subependymal haemorrhage only were similar. Babies with intraventricular haemorrhage had lower median concentrations on day 1 (p less than 0.002) and day 2 (p less than 0.05) compared with those with subependymal haemorrhage and lower concentrations on day 0 (p less than 0.02) and day 1 (p less than 0.05) compared with those without haemorrhage. These findings suggest that in premature babies vitamin E, an antioxidant, protects endothelial cell membranes from oxidative damage and disruption and limits the magnitude of haemorrhage and its spread from the subependyma into the ventricles.