Vitamin E, comprising eight biologically active tocopherols, is an important antioxidant for the health and wellbeing of premature neonates.

It helps in scavenging free radicals, thereby reducing the risk of lipid peroxidation and oxidant injury in preterm  infants. However, to achieve these effects, higher serum levels of tocopherols are needed than those reached through routinely recommended oral doses of vitamin E. This underlined the need to evaluate higher doses of vitamin E supplementation to eliminate or reduce the risk of conditions such as retinopathy of prematurity (ROP).

Randomized controlled trials evaluating the efficacy of such high-dose supplementation have not been uniformly encouraging. On the other hand, there have been reports of serious toxicity following megavitamin E supplements in preterm infants. The primary objective of this Cochrane review was to evaluate the spectrum of benefits and risks of vitamin E supplementation in preterm infants. 

Trials that randomized preterm infants or those with a birth weight <2500 g to supplementation with vitamin E (intervention) or placebo/no treatment were eligible for inclusion in the review. Studies were included regardless of the vitamin E content of the infant’s feedings (human or formula milk) or the route of vitamin E supplementation (parenteral or oral).

The reviewers excluded studies in which vitamin E had been provided as a co-intervention. The primary outcome measures included mortality until discharge from hospital, combined outcome at 18 months including mortality (bronchopulmonary dysplasia, blindness, mental retardation or cerebral palsy, and mortality), and combined outcome
at 18 months excluding mortality. The major secondary outcomes were sepsis, severe intraventricular haemorrhage (IVH) (grade III or IV), severe ROP, necrotizing enterocolitis with gastrointestinal perforation, signs of haemolysis, and local reaction at the injection site.