Failure of supplementation with vitamin E to prevent bronchopulmonary dysplasia in infants less than 1,500 g birth weight

Abstract

In a randomized trial to determine whether oral vitamin E reduced stages III and IV bronchopulmonary dysplasia (BPD) by 50%, 268 infants were randomly allocated, after stratification by birth weight and severity of disease, to receive vitamin E 25 units or an indistinguishable placebo. The experimental (E) group and the control (C) group were similar in weight, gestational ages, Apgar scores, severity of illness, and initial oxygen and ventilator exposure. Serum vitamin E levels were significantly different within 48 h of administration and remained well above normal adult levels from the first week of life in the experimental group. There was no difference in the rates of early death, BPD at 28 days, or mortality from BPD. Severity was similar and no difference was seen in the incidence of necrotizing enterocolitis or sepsis. There was no evidence that vitamin E supplementation offered protection against chronic lung disease in infants less than 1,500 g birth weight.

Vitamin E Status in Preterm Infants: Assessment by Plasma and Erythrocyte Vitamin E‐Lipid Ratios and Hemolysis Tests

“…The low plasma vitamin E levels (<11.6 μmol/l) in 75% of our patients are similar to those reported in previous studies(6,10,12,13,18,21‐24). Despite a low vitamin E intake, the E level rose rapidly after birth; and on day 3, levels were no longer deficient in most infants.…”

“…However, clinically, blood measurements must be used to assess vitamin E status. Many parameters have been suggested: plasma vitamin E levels(6,10,12,13,18,21,22,24), or vitamin E‐total‐lipid ratio (10,18,21), erythrocyte vitamin E levels(16,20‐23) and different HPH test values (28,30,31). Although a combination of tests is advised (14), such a method has scarcely been studied in preterm infants(10,18,21).…”

“…Deficiency can be produced by poor dietary intake or by excess oxidative consumption (oxygen therapy [6], high intake of iron or polyunsaturated fatty acids [7,10,11]). Pharmacologic dosages to prevent oxygen toxicity (bronchopulmonary dysplasia[7,12] and retinopathy of prematurity[7,13]) may, however, increase the risk of infections and necrotizing enterocolitis (8,9). Thus, careful monitoring of vitamin E status in preterm infants is required, but no consensus has been reached on the best method(14).…”

Role of cytokines in hyperoxia mediated inflammation in the developing lung

“…No clinical improvement has been demonstrated after the use of Vitamin E in infants less than 1500g (66).…”

“…Supplementing the immature antioxidant system of the preterm infant has been attempted using a number of pharmacological agents including Vitamin E, Vitamin A and superoxide dismutase (SOD) (66,67). Vitamin A supplementation has been associated with a modest reduction in CLD amongst survivors at 36 weeks, however administration is via repeated intramuscular injections (68).…”