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

BACKGROUND:Vitamin E is an essential component of the antioxidant defenses, but supplementation can have side effects in the preterm infant. Careful monitoring of vitamin E status is thus essential, however no consensus has been reached on the best clinical method. METHODS:In 47 healthy preterm infants, several methods for assessment of vitamin E status were evaluatedplasma and erythrocyte vitamin E levels were measured, vitamin E lipid ratios were calculated, and two variations of the hydrogen peroxide hemolysis test were conducted. RESULTS:At birth, the plasma and erythrocyte vitamin E levels were low. After birth, the plasma levels rose gradually, whereas the erythrocyte levels remained low. In contrast, the vitamin E-total-lipid ratio was in the low normal range from birth onwards. Vitamin E-lipid ratios using two lipid components (cholesterol with triglycerides, or cholesterol with phospholipids) or one lipid component (cholesterol) correlated with the vitamin E-total-lipid ratio with a good sensitivity and specificity. The susceptibility of erythrocytes to hydrogen peroxide-induced damage (measured as potassium release or malondialdehyde production) was high at birth and declined after birth. However, this susceptibility did not correlate with plasma or erythrocyte vitamin E levels or vitamin E-total-lipid ratio, and the hydrogen peroxide hemolysis test is not a reliable indicator of vitamin E status in preterm infants. CONCLUSIONS:Our study indicated that a gold standard for clinical assessment of vitamin E status in preterm infants is yet to be found.