PEDIATRICS Vol. 75 No. 4 April 1985, pp. 619-638
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Relationship of Prolonged Pharmacologic Serum Levels of Vitamin E to Incidence of Sepsis and Necrotizing Enterocolitis in Infants with Birth Weight 1,500 Grams or Less

Lois Johnson MD1, Frank W. Bowen Jr MD1, Soraya Abbasi MD1, Nira Herrmann PhD1, Marian Weston MS1, Linda Sacks MD1, Rachel Porat MD1, Gary Stahl MD1, George Peckham MD1, Maria Delivoria-Papadopoulos MD1, Graham Quinn MD1, and David Schaffer MD1

1 From the Departments of Pediatrics, Ophthalmology, and Research Medicine of the University of Pennsylvania, School of Medicine, Philadelphia; Pennsylvania Hospital, Children's Hospital of Philadelphia, and Hospital of the University of Pennsylvania, Philadelphia

The incidence of culture-proven neonatal sepsis and necrotizing enterocolitis (NEC) in preterm infants maintained at pharmacologic (mean 5.1 mg/dL ± 1.45 SD) serum vitamin E levels for long periods was prospectively studied as part of a double-masked clinical trial of the effect of prophylactic vitamin E v placebo treatment on the development and course of retinopathy of prematurity (ROP). Within a few days of birth, 914 preterm infants were enrolled in the study; 545 (275 placebo-treated infants, 270 vitamin E-treated infants had birth weight of 1,500 g or less. A significant difference in incidence of neonatal sepsis (17 placebo-treated infants, 37 vitamin E-treated infants) and NEC (18 placebo-treated infants, 32 vitamin E-treated infants) was observed among infants who had been treated for eight or more days and who had developed neither sepsis nor NEC before that time. The association of vitamin E treatment with increased incidence of disease was much higher with sepsis than with NEC. The most likely reason for these observations is a pharmacologic serum vitamin E-related decrease in oxygen-dependent intracellular killing ability which results in a decreased resistance to infection in preterm infants. The data suggest that, if this occurs, it is clinically significant only in the more immature infants. In view of the known variability of absorption of oral vitamin E and the association between high serum vitamin E levels and increased incidence of sepsis and late-onset NEC reported here, it can be concluded that serum vitamin E levels must be monitored when supplemental vitamin E is administered to premature infants, especially those with birth weight 1,500 g or less. The risk-benefit ratio of long-term treatment using vitamin E at high serum levels should be clearly assessed.

Key Words: vitamin E • sepsis necrotizing enterocolitis

Accepted on November 16, 1984




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 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A Pathak, P Roth, J Piscitelli, and L Johnson
Effects of vitamin E supplementation during erythropoietin treatment of the anaemia of prematurity
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2003; 88(4): F324 - F328.
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