American Journal of Clinical Nutrition, Vol 27, 1158-1173, Copyright © 1974 by The American Society for Clinical Nutrition, Inc.

The premature infant, vitamin E deficiency and retrolental fibroplasia

¹ From the Department of Pediatrics, The University of Pennsylvania Medical School, Section on Newborn Pediatrics, The Pennsylvania Hospital, and Division of Pediatric Ophthalmology, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania

Immature human infants develop retrolental fibroplasia in the absence of oxygen abuse, though fortunately much less frequently and to a less severe degree than in its presence. The incidence of acute stage retrolental fibroplasia among 173 infants weighing less than 2,500 g who were cared for at the Pennsylvania Hospital from 1968 to 1972 was 19% with an incidence of 32% in the 1,000- to 1,500-g weight group and of 75% among the six survivors in the 1,000-g weight category. The severity of the disease did not usually exceed grade 2 active retrolental fibroplasia but six instances of grade 3 disease and one of grade 4 were noted. The infants eyes were examined weekly by indirect ophthalmoscopy during the period of hospitalization. A follow-up after age 1 year is in progress with preliminary results indicating an incidence of cicatricial disease of 90% and of other eye patholgy (myopia, strabismus) of 80%. Both FIO₂ and PaO₂ are carefully monitored in our nurseries. Human retinal vessels normally develop entirely in the intrauterine environment. They are peculiarly sensitive to changes in O₂ tension. Therefore, in the prematurely born, these vessels are exposed to abnormally high O₂ tensions even in the absence of O₂ therapy. Premature infants are, to a greater or lesser degree, deficient in vitamin E, the natural antioxidant of biological membranes. The possibility that vitamin E deficiency predisposes to the development of retrolental fibroplasia is being investigated by a clinical trial in which alternate infants are started on treatment with parenteral vitamin E or a placebo within 4 to 24 hours of birth. Retinas are examined weekly during the period of vessel immaturity or proliferative retrolental fibroplasia, and biweekly or monthly during the stage of stabilization and regression of the disease process. The incidence of cicatricial retrolental fibroplasia and of related sequelae is being assessed by examination under anesthesia at 1 year of age. On the basis of a 20-month experience, treatment with vitamin E appears to result in a reduction in overall incidence and a decrease in both severity and duration of acute stage disease. Healing appears also to be favorably influenced. The greatest effect is found in the more premature infants (under 1,500 g birth weight).