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Vitamin E status in preterm infants: assessment by plasma and erythrocyte vitamin E-lipid ratios and hemolysis tests
D van Zoeren-Grobben1, N J Jacobs, E Houdkamp
1Department of Pediatrics, University Hospital Leiden, The Netherlands.
Insights
Monitoring vitamin E status in preterm infants is crucial due to supplementation risks. Current clinical methods, including plasma levels and hemolysis tests, are unreliable for assessing vitamin E status in these vulnerable infants.
Area of Science:
- Neonatal Nutrition
- Biochemistry
- Pediatric Medicine
Background:
- Vitamin E is vital for antioxidant defense in infants.
- Supplementation in preterm infants carries potential side effects.
- Accurate monitoring of vitamin E status is necessary but lacks a consensus method.
Purpose of the Study:
- To evaluate various clinical methods for assessing vitamin E status in preterm infants.
- To determine the reliability of plasma and erythrocyte vitamin E levels, vitamin E-lipid ratios, and hydrogen peroxide hemolysis tests.
Main Methods:
- Assessed vitamin E status in 47 preterm infants using plasma and erythrocyte levels.
- Calculated vitamin E-lipid ratios and conducted hydrogen peroxide hemolysis tests.
- Measured potassium release and malondialdehyde production in erythrocytes.
Main Results:
- Plasma vitamin E levels increased post-birth, while erythrocyte levels remained low.
- Vitamin E-total-lipid ratios were low-normal from birth; ratios with single or dual lipids showed good correlation.
- Hydrogen peroxide hemolysis test results did not correlate with vitamin E levels, indicating unreliability.
Conclusions:
- A definitive gold standard for clinical assessment of vitamin E status in preterm infants has not yet been established.
- The hydrogen peroxide hemolysis test is not a reliable indicator for preterm infants.
- Further research is needed to identify optimal methods for monitoring vitamin E status.
Background:
Vitamin E is an essential component of the antioxidant defenses, but supplementation can have side effects in the preterm infant. Careful monitoring of vitamin E status is thus essential, however no consensus has been reached on the best clinical method.
Methods:
In 47 healthy preterm infants, several methods for assessment of vitamin E status were evaluated: plasma and erythrocyte vitamin E levels were measured, vitamin E lipid ratios were calculated, and two variations of the hydrogen peroxide hemolysis test were conducted.
Results:
At birth, the plasma and erythrocyte vitamin E levels were low. After birth, the plasma levels rose gradually, whereas the erythrocyte levels remained low. In contrast, the vitamin E-total-lipid ratio was in the low normal range from birth onwards. Vitamin E-lipid ratios using two lipid components (cholesterol with triglycerides, or cholesterol with phospholipids) or one lipid component (cholesterol) correlated with the vitamin E-total-lipid ratio with a good sensitivity and specificity. The susceptibility of erythrocytes to hydrogen peroxide-induced damage (measured as potassium release or malondialdehyde production) was high at birth and declined after birth. However, this susceptibility did not correlate with plasma or erythrocyte vitamin E levels or vitamin E-total-lipid ratio, and the hydrogen peroxide hemolysis test is not a reliable indicator of vitamin E status in preterm infants.
Conclusions:
Our study indicated that a gold standard for clinical assessment of vitamin E status in preterm infants is yet to be found.