Amer J Perinatol 2018; 35(03): 305-310
DOI: 10.1055/s-0037-1607283
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vitamin E in the Preterm Infant: A Forgotten Cause of Hemolytic Anemia

Enrique Gomez-Pomar
1  Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky
Emily Hatfield
2  Division of Neonatology, Seattle Children's Hospital, Seattle, Washington
Karen Garlitz
3  Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky
Philip M. Westgate
4  Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
Henrietta S. Bada
1  Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky
› Author Affiliations
Funding None.
Further Information

Publication History

24 July 2017

02 September 2017

Publication Date:
10 October 2017 (eFirst)


Objective Vitamin E deficiency in premature infants has been associated with hemolytic anemia. Its incidence decreased after the supplementation of preterm formulas and parenteral nutrition with vitamin E. Despite this, some infants still develop hemolytic anemia and receive vitamin E.

Study Design Retrospective analysis of 70 infants admitted to a level IV intensive care unit and who developed hemolytic anemia and were treated with vitamin E. Infants were classified into two groups based on whether or not they responded to vitamin E therapy. Statistical methods included the use of descriptive statistics and marginal logistic regression models.

Results Low hematocrit and reticulocytosis before vitamin E administration were associated with adequate response to treatment. Thrombocytosis, iron treatment (duration and dose), gestational age, birth weight, and type of feedings were not. Infants who received a short duration of parenteral nutrition and were on oxygen responded to vitamin E therapy. Infants with a hematocrit ≤ 26% and reticulocyte of 36.1% were more likely to respond to vitamin E.

Conclusion Although formulas and parenteral nutrition are supplemented with vitamin E; some preterm infants may still develop hemolytic anemia. Those with anemia, reticulocytosis, and oxygen requirement may benefit from additional vitamin E.