The role of vitamin E therapy in high-risk neonates.

Infants are born with low tissue stores of tocopherol and accumulate this vitamin from feedings after birth. If prolonged malabsorption of tocopherol occurs, a recognized hemolytic anemia and spinocerebellar degeneration develops after a period of months to years. This is preventable with tocopherol supplementation. However, a benefit of tocopherol supplementation in premature infants who are transiently unable to feed after birth has been harder to prove. Pharmacologic doses have not definitively been shown to be beneficial in any of the putative oxygen toxicity syndromes, with the possible exception of PV/IVH. It is exciting that tocopherol appears to reduce significantly the incidence and severity of IVH, and this potential application underscores the urgent need for pharmacologic studies of this lipid nutrient. In order to administer the drug safely, we must establish the best means of assessing sufficiency and toxicity in premature infants. Measures of tissue capacity to resist oxidative stress appear to be the most promising of these tests at this time. In the interim, a working proposition is to provide sufficient tocopherol to these infants to raise the plasma levels into the range considered normal for term, breastfed infants.