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High risk infants remain selenium deficient despite recommended dosing

Susan Marshall

Objectives: Selenium (Se) is an essential trace mineral important in neonatal development that contributes to oxidative stress. Se deficiency in preterm infants is associated with late onset sepsis, bronchopulmonary dysplasia, and poor neurodevelopmental outcomes. It is unclear if American Society for Parenteral and Enteral Nutrition Se recommendations is sufficient. We evaluated if ASPEN recommended Se dosing (2 mcg/kg/d) is sufficient in high-risk infants.
Methods: We retrospectively reviewed Se levels from January 2017 to August 2019. Infants were included if they received total or partial TPN for �?�4 weeks. Normal Se status was defined as 45-90 ng/mL. Se deficient infants received Se dosing at 5-7 mcg/kg/d and were re-evaluated after 4 weeks. Results are reported as mean �?�SD.
Results: Selenium levels were assessed for 39 infants, average GA 29.8 �?�5.36 weeks and average birth weight 1499 �?�837 g. At first Se assessment, 78% of infants were deficient, with a mean Se level of 40.95 �?�12 ng/mL. After 4 weeks of higher Se dosing, 35% of infants remained deficient, with a mean of 54.04 �?�14 ng/mL. By t-test, fewer infants were Se deficient on higher dosing (p <0.0003).
Conclusion: Infants on prolonged TPN > 4 weeks are at high risk for Se deficiency. Se dosing at 2mcg/kg/day is insufficient for a majority of high-risk babies. Higher Se dosing improved the percentage of Se sufficient infants, but a third remained deficient. Future studies are needed to prospectively determine if higher Se in TPN prevents Se deficiency.