Vitamin A and E status in very low birth weight infants: Development of an improved parenteral delivery system,☆☆,,★★

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Abstract

Plasma vitamin A and E levels were inadequate in very low birth weight infants receiving a continuous infusion of a parenteral multivitamin preparation, 1.5 ml/kg per day, in dextrose-amino acid solution. A new delivery system using 2 ml/kg per day, infused for 6 hours from the first day of life, avoided loss during infusion and significantly improved plasma vitamin A and E levels during the first 28 days of life in very low birth weight infants. (J PEDIATR 1995;126:128-31)

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METHODS

Conventional delivery of vitamins A and E in our NICU consists of MVI Paediatric (Rhône-Poulenc Rorer, Auckland, New Zealand), 1.5 ml/kg per day, added to a 24-hour dextrose-amino acid (Vaminolact; Kabi Pharmacia, Stockholm, Sweden) infusion solution with black bag shielding, commencing on a mean of day 3 (SD 0.6) and infused at a rate of up to 150 ml/kg per day. Vitadol C (Karitane Products Society; distributed by Douglas Pharmaceuticals, Auckland, New Zealand), containing vitamins A, D, and

RESULTS

Plasma vitamin A and E levels were low in our population of VLBW infants receiving multivitamins by a conventional parenteral delivery system (Table). Vitamin A levels declined in the solution bag from 73% to 25% of prescribed values during a 24-hour period (Figure). At the efflux of the intravenous line, vitamin A levels were only 4% to 21% of prescribed values. By measuring the area under the curve, we found that this corresponded to a 24-hour calculated delivery of 6% of the prescribed

DISCUSSION

Our results show that many VLBW infants had plasma levels of vitamin A and E well below recommended minimal levels when a conventional multivitamin parenteral delivery mode was used. Investigation of the parenteral delivery system showed that the infants were receiving almost none of the vitamin A but most of the vitamin E prescribed. Previous studies have shown that this is caused by tubal adherence and photodegradation.8, 9, 10 In our study, adherence to the tubing can account for the initial

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From the Departments of Paediatrics, Christchurch and Dunedin Hospitals, and the Department of Pathology, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.

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Supported by the New Zealand Lottery Board, New Zealand Health Research Council, and the Grand Lodge of New Zealand Freemasons.

Reprint requests: B.A. Darlow, MD, FRACP, Department of Paediatrics, Christchurch Hospital, Private Bag, Christchurch, New Zealand.

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0022-3476/95/$3.00 + 0 9/24/59439

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