HPLC Tracks Vitamin E and A Levels in NICU Infants

Babies in the neonatal intensive care unit (NICU) can end up with either too little or too much of certain vitamins, especially vitamins E and A, because their bodies have not built up much of a reserve yet, and many of them need to get their nutrition through an intravenous IV for a long time. To better understand this, researchers looked back at medical records for babies who had been in the NICU and had their vitamin E or A levels checked with high-performance liquid chromatography (HPLC). The goal was to see what happens when babies get more vitamins through their IV, and how that relates to the actual vitamin levels in their blood. The researchers also looked at whether these vitamin levels were connected to health outcomes for the babies, and whether the mother's ethnicity played any role. A paper based on this research was published in the Journal of Paternal and Eternal Nutrition.¹

Why Do Vitamin E and A Matter for Premature Babies, and Why is This Worth Examining?

Premature babies are at risk of having either too little or too much of certain vitamins (the fat-soluble kind) in their blood, because they haven't built up much of a reserve yet and often depend on IV feeding.² Doctors have looked into giving premature babies extra-high doses of vitamin E as a way to try to prevent certain complications. The idea is that these babies often need a lot of supplemental oxygen, which can cause damage to the lungs, brain, and eyes, and vitamin E might help protect against that kind of damage.³ In a similar way, some researchers think vitamin A might help premature babies' lungs and eyes develop properly, potentially lowering their risk of chronic lung disease and eye problems linked to premature birth. This is because vitamin A plays a role in how lung tissue genes are switched on and off, helps the lungs make a substance they need to work properly (called surfactant), and is also a building block for a protein in the eye that helps babies see.⁴ However, not much research has examined into how the amount of vitamins babies get connects to their blood levels and how they end up doing health-wise. There's some evidence that giving higher doses of fat-soluble vitamins like vitamin E could do more harm than good, raising the risk of side effects or the vitamin building up to toxic levels.^5,6

Does Receiving Vitamins E and A Affect the Blood Levels of MICU Babies?

The researchers found that the longer babies were fed through an IV, the higher their vitamin E levels tended to be , a connection that was clear in their minds. But the same was not true for vitamin A, as how long they were on IV feeding did not seem to make a difference there. Also, giving babies vitamins by mouth or feeding tube (rather than through the IV) did not seem to affect their blood levels either way.¹

Babies who developed necrotizing enterocolitis (a serious gut condition) tended to be on IV feeding longer, and this may explain why they were more likely to have high vitamin E levels. In addition, having those high vitamin E might raise the risk of bleeding in the gut.¹

Finally, there were no real differences between babies of different ethnic backgrounds when it came to how sick they got, whether they survived, or how much vitamin they received.¹

Serum vitamin A and E concentrations in neonatal intensive care infants did not consistently reflect intakes,” write the authors of the paper.¹ “Prolonged intravenous nutrition increases the risk of high serum vitamin E concentrations. Prospective studies are needed to clarify these risks and to inform targeted formulation of intravenous vitamin products for preterm infants.”

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References

1. Bronnert, A.; Kremer, L.; Harding, J. E. et al. Associations Between Intake of Vitamins E and A and Serum Concentrations in Preterm Infants: A Retrospective Cohort Study. JPEN J Parenter Enteral Nutr. 2026.DOI: 10.1002/jpen.70141
2. Puntis, J.; Hojsak, I.; Ksiazyk, J. et al. ESPGHAN/ESPEN/ESPR/CSPEN Guidelines on Pediatric Parenteral Nutrition: Organisational Aspects. Clin Nutr. 2018, 37 (6 Pt B), 2392-2400. DOI: 10.1016/j.clnu.2018.06.953
3. Bell, E. F. History of Vitamin E in Infant Nutrition. Am J Clin Nutr. 1987,46 (1 Suppl), 183-186. DOI: 10.1093/ajcn/46.1.183
4. Rakshasbhuvankar, A. A.; Pillow, J. J.; Simmer, K. N. et al. Vitamin A Supplementation in Very-preterm or Very-low-birth-weight Infants to Prevent Morbidity and Mortality: A Systematic Review and Meta-analysis of Randomized Trials. Am J Clin Nutr. 2021, 114 (6), 2084-2096. DOI: 10.1093/ajcn/nqab294
5. Phelps D. L. Current Perspectives on Vitamin E in Infant Nutrition. Am J Clin Nutr. 1987, 46 (1 Suppl), 187-191. DOI: 10.1093/ajcn/46.1.187
6. Roberts, R. J.; Knight, M. E. Pharmacology of Vitamin E in the Newborn. Clin Perinatol. 1987, 14 (4), 843-855. PMID: 3322628.