Impact of Vitamin C Supplementation in Reducing Oxidative Stress in Preterm Neonates: A Randomized Open-label Study

Abstract Context: Preterm birth remains the leading cause of neonatal mortality worldwide and contributes substantially to neonatal deaths in India. Ascorbic acid (Asc.A) (Vitamin C) is an important antioxidant involved in immune function and protection against oxidative stress. Vitamin C concentration declines rapidly after birth in preterm neonates. Evidence supporting the role of Vitamin C supplementation in reducing respiratory morbidity (oxidative stress) in preterm neonates, in developing countries is limited. Aims: The study aimed to investigate the impact of Asc.A on reducing the oxidative stress in preterm neonates by assessing Asc.A levels and corresponding change in malondialdehyde (MDA) levels. Settings and Design: A randomized, open-label, interventional study in a Level III-A neonatal intensive tertiary care unit. Materials and Methods: One hundred and thirty preterms with gestational ages <37 weeks and birthweight <2.5 kg were equally allocated to case and control groups. The case group received Asc.A supplementation of 40 mg/kg/day till discharge day. Asc.A and MDA levels were measured on day 2 of life and at discharge. Statistical Analysis Used: Statistical analysis was performed using the SPSS software (version 20). Results: At discharge, case group demonstrated significant increase in Asc.A levels (+1.22 mg/dL; P < 0.0001), while control group showed reduction (−0.98 mg/dL; P < 0.0001). MDA levels showed a substantial reduction in the supplementation group (−4.34 μmol/L; P < 0.0001) evidence of reduced oxidative stress compared with controls (−1.55 μmol/L; P < 0.0001). Improvement in Asc.A levels correlated positively with reduction in MDA. Conclusions: Asc.A supplementation in preterm neonates was associated with significant reduction in oxidative stress. Given its safety, affordability, and biological efficacy, Asc.A/Vitamin-C supplementation may serve as a valuable adjunct to standard neonatal care, with potential relevance to national initiatives such as the National Newborn Action Plan.