Dose: 5 to 25 IU/Day
PO (see comments).
1 to 2
mg/kg/Day IM (see comments).
Vitamin E (alpha tocopherol)
| Dose: 5 to 25 IU/Day
PO (see comments). |
| Frequency: Q Day |
| Comments: Term infants fed breast milk or formula do not need vitamin E supplementation. Preterm infants fed their mother's milk and those who receive formula should receive an oral supplement of 5-25 IU/day, the lower amount should be sufficient for infants receiving breast milk. Both preterm and term infants on TPN should receive 2 IU/kg/day of vitamin E per day which the infant will receive via MVI-pediatric. Infants who are receiving erythropoietin should be supplemented with 25 IU/day (see erythropoietin). At the present time the use of pharmacological doses of vitamin E is not recommended routinely for any infants. Sources of vitamin E include: |
Source |
Amount of vitamin E available |
| Multivitamins | 5 IU/ml |
| Human Milk (term) | 0.7 to 1.9 IU/100 kcal |
| Human Milk (preterm) | 0.9 to 2.2 IU/100 kcal |
| Similac 20 cal/oz | IU/100 kcal |
| SC-20 | 4.0 IU/ 100kcal |
| SC-24 | 4.0 IU/ 100kcal |
| Isomil | 3.0 IU/ 100kcal |
| Pregestimil | 2.3 IU/ 100kcal |
| Portagen | 2.3 IU/ 100kcal |
| MVI (< 1000 grams) | 7 IU/5 ml |
| MVI (1000 to 3000 grams) | 4.5/3.25 ml |
| MVI (> 3000 grams) | 2.1 IU/1.5 ml |
Infants with cholestasis have decreased absorption of vitamin E. With severe persisting cholestasis, almost complete malabsorption of the vitamin occurs. With less severe impairment, oral therapy may be effective. Generally, doses of 0.3 cc (50 IU) are used initially and increased to a daily oral total of 150 IU or 200 IU. If this is ineffective, intramuscular vitamin E can be administered with doses ranging from 1 to 2 mg/kg/day. The best measure of adequate vitamin E is obtained by monitoring the vitamin E to total serum lipid concentration (< 0.8 mg/gram is abnormal). Long-term cholestasis and vitamin E deficiency may lead to a degenerative neurological condition. Further comments on vitamin E.
| Toxicity: One report (Johnson, Pediatrics, 75:619, 1985) noted a near three-fold increase in the incidence of sepsis and NEC in infants who received vitamin E to maintain serum levels near 5 mg/dl (50 mcg/ml). In another study, Finer, (Pediatrics, 73:387, 1984) found a two-fold increase in the incidence of NEC in VLBW infants who received pharmacological doses of vitamin E. Levels were not routinely measured, but in nine infants in whom they were obtained prior to the NEC, the mean level was 3.1 mg/dl (31 mcg/ml) with only one infant having a level greater than 3.5 mg/dl (35 mcg/ml). |
| Preparation: IM: Not currently available |
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