Case series of selenium insufficiency among infants with intestinal failure

Background: Selenium (Se) is an essential trace element incorporated into 'selenoenzymes' that are necessary for immune, thyroid and antioxidant responses. Infants with intestinal failure (IF) require prolonged administration of parenteral nutrition (PN). This report presents a series of infants with IF who demonstrate biochemical Se deficiency despite PN supplementation, which normalized following dose escalation. Case Series: Patient 1 was born at 25 weeks' gestation, birthweight 870 g, with intestinal malrotation and colonic atresia. Patient 2 was born at 28 weeks' gestation, birthweight 1130 g, with multiple congenital anomalies. Patient 3 was born at 34 weeks' gestation, birthweight 3030 g with gastroschisis and midgut volvulus requiring significant bowel resection. Their serum Se levels ranged from 56 to 93 (reference range 100-340 µg/L) prior to dose changes. Conclusion: Preterm birth, bowel resection and intestinal failure are risk factors for Se deficiency. High quality studies of PN Se supplementation in preterm infants with IF are needed to determine the optimal dose for this high-risk population.