To      :  Carla D'Anna
Re      :  Vitamin E

        I noted with interest your problem concerning Vitamin E cream,  and
refusal of the physician to listen to reason.  There's not much you can do
about ignorance,  but throw some good reason at it,  then ...

        Vitamin E has a rather sorted past in neonatal literature.  In 1984
it was found to produce hepatosplenomegally,  and actually killed at least
38 infants in neonatal ICUs in the US.  This vitamin E was administered via
IV at about 25 IU per day to attempt to prevent oxygen toxicity to the
retina(it didn't work).  Vitamin E concentrates in large quantities in the
liver, sometimes so much that you can stain liver sections and see large
lipid(vit. E) droplets in the cytoplasm of the hepatocyte. The FDA should
have a lot of literature on vitamin E toxicity from the 80's,  because it
was thoroughly investigated.

        I am particularly worried about the use of pure vitamin E oil,
which when applied to the nipple, is easily ingested  and the doses can be
extraordinarily high(100's of mg/day) which could possibly lead to
hepatotoxicity.  Many of the vitamin E topical creams contain 50-100 IU per
gram of cream(1/2 inch), so you can see the ingested dose after 4-10 nipple
applications per day could get rather high.

        Therefore, common sense suggestions would be to limit the topical
application of vitamin E to very low doses, less than 25-50 IU per day, and
then only for short duration. I would specifically NOT use the edible pure
vitamin E oil(approx. 670 IU/gram),  as it is simply too concentrated.
Remember, any left on the nipple will be ingested by the infant and go
directly to the liver.  The recommended ADULT RDA is about 15 IU/day.
Hypervitaminosis E symptoms include fatigue, weakness, nausea, blurred
vision, diarrhea.  Finally,  I would do anything possible to reduce the
overall dose ingested by the infant.


Tom Hale, Ph.D.