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An evaluation of vitamin E status in premature infants
Insights
Premature infants often have low vitamin E levels. This study shows these low levels indicate a true deficiency, not just age-adjusted values, and warrant early treatment for optimal antioxidant protection.
Area of Science:
- Neonatology
- Nutritional Biochemistry
- Pediatric Research
Background:
- Premature infants and low birth weight infants exhibit lower plasma vitamin E concentrations compared to adults.
- The clinical significance of these low levels is debated: are they age-adjusted norms or indicative of deficiency?
Purpose of the Study:
- To investigate vitamin E status in prematurely born, low birth weight infants.
- To determine the optimal plasma vitamin E concentrations for adequate antioxidant protection in this population.
- To ascertain if early vitamin E treatment is warranted for preterm infants.
Main Methods:
- Assessment of multiple vitamin E status measures in 62 preterm, low birth weight infants.
- Application of mathematical and statistical modeling to analyze vitamin E levels over the first 21 days of life.
Main Results:
- Optimal ex utero antioxidant protection by vitamin E is achieved at plasma concentrations similar to adults.
- Specific thresholds identified: total tocopherol > 0.64 mg/dl and alpha-tocopherol > 0.50 mg/dl.
- Most preterm, low birth weight infants are vitamin E deficient at birth.
Conclusions:
- A true vitamin E deficiency state exists in most preterm, low birth weight infants at birth.
- Early vitamin E supplementation is recommended to ensure adequate antioxidant status.
- Maintaining adult-like plasma vitamin E levels is crucial for preterm infants' health.
Abstract:
Prematurely born, low birth weight infants are abnormal by their very existence ex utero. Thus, the well-documented finding in such infants of low plasma vitamin E concentrations when compared to the adult poses philosophical and pragmatic difficulties as to whether or not a true deficiency state exists: do these low levels represent age-adjusted reference values or do they in fact represent a deficiency state, warranting treatment? We examined multiple measures of vitamin E status in 62 prematurely born, low birth weight infants in order to address this issue. Mathematical and statistical modeling of these measures during the first 21 days of life lead us to conclude that the ex utero antioxidant protective role of vitamin E is best achieved at plasma concentrations of tocopherol very close to those observed in the adult; specifically, when total tocopherol is greater than 0.64 mg/dl and alpha-tocopherol is greater than 0.50 mg/dl. Thus, at birth, a true deficiency in vitamin E exists for most preterm, low birth weight infants and early treatment is warranted.