Effect of oral vitamin E supplementation in children with cholestasis.

OBJECTIVE: Malabsorption and deficiency of vitamin E are common consequences of chronic cholestasis. The objective of this study was to determine vitamin E status by using plasma vitamin E/total lipid ratio (E/L) in children with cholestasis during supplementation with 20 IU/kg/day and 100 IU/kg/day of oral vitamin E capsule, and 50 IU/kg/day of cold water soluble form (CWSIF) of vitamin E. METHOD: Children with cholestasis who were being supplemented with 20 IU/kg/day of oral vitamin E capsule (dl-alpha-tocopherol) were enrolled into this study. After initial evaluation for vitamin E status and liver function, doses of oral vitamin E supplementation were increased to 100 IU/kg/day for 1 month. Then, supplementation was switched to 50 IU/kg/day of CWS/F vitamin E for 1 month. Vitamin E status was assessed by using plasma E/L after each period of supplementation. RESULTS: Eleven children with biliary atresia, aged between 2 and 18 months, were studied. Their median weight standard deviation score (SDS) was -1.35 and median height SDS was -1.26. The medians of serum direct bilirubin and total bilirubin were 6.5 and 12.9 mg/dl, respectively. Only 2 and 3 out of 9 children had plasma E/L above normal cut-off levels during supplementation with 20 and 100 IU/kg/day of vitamin E capsule, respectively. Additionally, 4 of 9 children had plasma E/L above normal cut-off level after one month's supplementation with 50 IU/kg/day of CWS/F vitamin E. All the responders had serum bilirubin levels less than 4 mg/dl while the remainder with serum direct bilirubin level more than 4 mg/dl had their plasma E/L below normal cut-off levels in spite of any vitamin E supplementation. CONCLUSION: Oral vitamin E supplementation with 20 IU/kg/day and 100 IU/kg/day of vitamin E capsule and with 50 IU/kg/day of CWS/F vitamin E were able to normalize vitamin E status in a few cholestatic children who had serum direct bilirubin levels less them 4 mg/dl. In cases of serum direct bilirubin more than 4 mg/dl, neither of vitamin E supplementations was able to correct the vitamin E deficiency status.

Vitamin A status in premature infants.

BACKGROUND: Premature infants are at risk of vitamin A deficiency due to inadequate transplacental transport, inadequate storage and increased tissue utilization. Previous studies reported a significant decrease in serum vitamin A levels in premature infants at birth compared to those of full term infants. OBJECTIVE: To determine serial changes of plasma vitamin A status during the first month of life in 19 healthy, very low birth weight premature infants. METHOD: Subjects were fed with premature infant formula and received multivitamin supplementation. Plasma vitamin A concentrations were measured at 7, 14, and 30 days of age. RESULTS: Plasma vitamin A levels at 7,14 and 30 days of age were 24.63 +/- 6.08, 30.97 +/- 5.26 and 30.68 +/- 7.14 microg/dl, respectively. Plasma vitamin A levels at age 7 days were significantly lower than those at 14 and 30 days of life (p < 0.001). Three infants out of 19 (16%) had low plasma vitamin A (<20 microg/dl) at 7 days. At 14 and 30 days of age, all infants had normal plasma vitamin A levels. CONCLUSION: The results suggested that healthy premature infants were prone to subclinical vitamin A deficiency during the first week of life which could be treated by adequate enteral feeding and routine multivitamin supplementation. A high dose of vitamin A supplementation was not necessary in healthy premature infants.