Vitamin E and Necrotizing Enterocolitis

Abstract

Although vitamin E has been shown to reduce the incidence of severe sequelae from retrolental fibroplasia, there have been recent suggestions that its use may be associated with an increased incidence of necrotizing enterocolitis (NEC). A review was made of experience with vitamin E, both intramuscular and oral, and NEC over a 4½-year period. Of 418 infants of birth weight less than 1,500 g admitted during this period, 28/209 infants who had received vitamin E had definite NEC (13.4%) compared with 12/209 who had not received vitamin E (5.74%, χ² = 7.07, P = .008). For infants of birth weight less than 1,250 g, 16/103 infants who received vitamin E developed NEC v 1/159 who had not (χ² = 21.1, P < .001); the incidence of NEC was not significantly different between the two groups for infants with birth weight between 1,250 to 1,500 g. The early mortality (< seven days) for infants with birth weight of 1,500 g or less was significantly greater for those who had not received vitamin E (43.5% v 13.8%, χ² = 44.9, ^P < .001), most probably a reflection of the omission of this drug for the most critically ill infants in this retrospective review. The incidence of NEC was not different for infants with birth weight of 1,500 g or less who received intramuscular vitamin E compared with control infants from the same period. For those infants for whom serum tocopherol levels were available, no infant who developed NEC and who had received only oral vitamin E had a serum tocopherol level of greater than 3.5 mg/100 mL. The increased incidence of NEC appeared to be associated with an oral dose of 200 mg of vitamin E of the currently available hyperosmolar preparation. In an effort to reduce serious eye sequelae from retrolental fibroplasia, infants with birth weight less than 1,250 g who require oxygen should receive either parenteral vitamin E or a low osmolar oral preparation within 12 hours of birth.