Variability in the dose of intravenous vitamin E given to very low birth weight infants

Objective: Vitamin E is required by very low birth weight (VLBW) infants to prevent vitamin E deficiency. However, prolonged intravenous intakes of vitamin E >4 international units (IU)/kg/day often yield potentially toxic serum tocopherol levels. This study was designed to assess the frequency of potentially inadequate or excessive doses of intravenous vitamin E in parenteral nutrition for VLBW infants in the US. Study Design: A questionnaire was sent to the 100 neonatal-perinatal training program centers listed in the 2003 directory (American Academy of Pediatrics (AAP)). Using the information provided for each neonatal unit, we calculated the doses of vitamin E (IU/kg/day) that would have been given to infants with body weights of 0.5, 1.0 and 1.5 kg in that unit. The doses were then recoded as inadequate if less than recommended (2.8 IU/kg/day, maximum 7 IU/day) by the American Society for Clinical Nutrition and the AAP, and excessive if >4 IU/kg/day, and frequencies were compared χ² analysis. Results: The 65 centers that responded were predominantly among those that offered the highest level of subspecialty neonatal intensive care (level IIID). The predicted dose of vitamin E had a median value of 2.8 IU/kg/day for all three weights, and was no significantly different among the three weights. VLBW infants with weights of 0.5, 1.0 and 1.5 kg were predicted to receive doses <2.8 IU/kg/day in 12, 12 and 19% of the neonatal intensive care units (NICUs), respectivelv, and doses >4 IU/kg/day in 40, 31 and 10% of the NICUs, respectively. Excessive doses were significantly associated with body weight, with more frequent excessive doses at lower weight (p = 0.0008). Conclusion: This survey showed a lack of uniformity of dosing of intravenous vitamin E in VLBW infants. The smallest infants (< 1.0 kg) were receiving excessive, potentially toxic doses of vitamin E in a significant number of NICUs in the US in 2003.