Selenium Supplementation for Premature Neonates

Preterm neonates are babies born more than three weeks before the normal term, i.e. born before the 37th week of gestation. Sepsis – the condition caused by harmful bacteria entering the blood circulation – is one of the complications associated with premature birth. Selenium supplementation can reduce the risk of late-onset sepsis in preterm neonates.

Selenium supplementation reduces the risk of sepsis in premature babies.

Three studies carried out in low-selenium countries – Australia, New Zealand, and India – have shown a positive effect of selenium supplementation in reducing the incidence of sepsis in premature babies [Daniels; Darlow; Aggarwal].

Selenium supplementation – both selenium fed orally and selenium fed parenterally – significantly improved the selenium status of premature babies and reduced the incidence of “late onset” sepsis [Darlow].

In none of the three clinical studies were there any adverse reactions to the selenium supplementation [Daniels; Darlow; Aggarwal].

Increased Risk of Sepsis in Premature Babies Without Selenium Supplementation

“Late onset” sepsis presents, typically, one week or more following birth and is caused by exposure to infection in the hospital.  A “late onset” sepsis occurs in about one out of five premature babies with a birth weight below 1500 grams (about 3 pounds and five ounces).

By contrast, “early onset” sepsis presents within the first seven days of birth and is usually caused by exposure to infectious microorganisms during the period from the beginning of labor through the delivery of the placenta.

Premature babies born as early as the 22nd week of pregnancy have a 58% chance of contracting sepsis while premature babies born in the 28th week of pregnancy have a 20% risk of sepsis [Camacho-Gonzalez].

The normal length of human gestation about 40 weeks, measured from the first day of the woman’s last menstrual period.

Decline in Infants’ Selenium Status Following Birth is Common

A common development in the weeks following birth is a significant fall in the serum selenium concentration of babies, both pre-term babies and babies carried to term [Muntau].

The difference is that premature babies weighing less than 1500 grams (about three pounds and five ounces) are born with much lower serum selenium concentrations to begin with.

Consequently, when the premature babies’ serum selenium levels begin to fall in the weeks after birth, they fall to dangerously low levels [Daniels]. Accordingly, premature babies have a high risk of selenium deficiency in the weeks following birth and, at the same time, a high risk of sepsis.

Importance of the Micronutrient Selenium

Selenium in the diet is essential in small amounts.  It carries out its many biological functions as a component of 25 selenoproteins.  Among the most important of these selenoproteins are the glutathione peroxidases, the thioredoxin reductases, the iodothyronine deiodinases, and the selenoprotein P.

Selenium and selenoproteins play an important role in the following biological functions:

  • Antioxidant protection against oxidative damage
  • Proper immune system function
  • Proper thyroid function
  • Protection against infectious diseases, e.g. AIDS, sepsis

Some observational studies and some experimental studies have shown a chemopreventive effect of selenium exposure or supplementation on certain types of cancer.

Selenium deficiency is associated with increased risk of Keshan heart muscle disease [Chen] and Kashin-Beck osteo-arthropathy [Zou].

Summary: Improved Selenium Status = Less Risk of Sepsis in Premature Babies

The supply of the essential trace element selenium in food varies considerably from region to region depending primarily on the selenium content in the soil.  Many countries in Europe, especially countries in the Scandinavian region (except Finland, which fertilizes the soil with selenium) and in the Middle East are known to be selenium-poor regions [Stoffaneller & Morse].

The states on the east and west coasts of the United States generally have lower selenium content in the soil than do the states in the middle of the country [National Research Council].

Supplemented infants with low birth weight below 1500 grams (three pounds and five ounces) received 7 micrograms/kilogram/day of selenium parenterally or 5 micrograms/kilogram/day of selenium orally.  Significantly fewer supplemented infants had a diagnosis of sepsis after the first week of life (p < 0.038).

More research into the optimal form and dosage of selenium for premature infants is needed.

Conclusion: Selenium Supplementation for Antioxidant Protection

Sepsis is a serious, potentially life-threatening condition that is caused by the immune system’s response to an infection.  Sepsis is accompanied by a systemic inflammatory response syndrome, which typically involves extreme oxidative stress.

Consequently, supplementation with antioxidant micronutrients like selenium can improve the clinical outcome for infected patients by neutralizing harmful free radicals.  Two meta-analysis studies have shown that selenium supplementation of patients with sepsis and systemic inflammatory response syndrome significantly reduces the risk of mortality [Alhazzani; Huang].

Further study is needed to determine the appropriate mode of administration, dosage, and duration of the selenium treatment.


Aggarwal, R., Gathwala, G., Yadav, S., & Kumar, P. (2016). Selenium supplementation for prevention of late-onset sepsis in very low birth weight preterm neonates. J Trop Pediatr, 62(3):185-93.

Alhazzani, W., Jacobi, J., Sindi, A. & Jaeschke, R.Z. (2013). The effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med, 41(6):1555-1564.

Camacho-Gonzalez, A., Spearman, P.W. & Stoll, B.J. (2013). Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am, 60(2):367-89.

Chen, J. (2012).  An original discovery: selenium deficiency and Keshan disease (an endemic heart disease). Asia Pac J Clin Nutr, 21(3):320-326.

Daniels, L., Gibson, R. & Simmer, K. (1996). Randomised clinical trial of parenteral selenium supplementation in preterm infants. Arch Dis Child Fetal Neonatal Ed, 74(3):F158-164.

Darlow, B.A., Winterbourn, C.C., Inder, T.E., Graham, P.J., Harding, J.E., Weston, P.J., Austin, N.C., Elder, D.E., Mogridge, N., Buss, I.H. & Sluis, K.B. (2000). The effect of selenium supplementation on outcome in very low birth weight infants: a randomized controlled trial. The New Zealand Neonatal Study Group. J Pediatr, 136(4):473-80.

Huang, T.S., Shyu, Y.C., Chen, H.Y. & Chen, P.J. (2013) Effect of parenteral selenium supplementation in critically ill patients: a systematic review and meta-analysis. PLoS One, 8(1): e54431.

Muntau, A.C., Streiter, M., Kappler, M., Röschinger, W., Schmid, I., Rehnert, A., Schramel, P. & Roscher. A.A. (2002). Age-related reference values for serum selenium concentrations in infants and children. Clin Chem, 48(3):555-60.

National Research Council. (1983). Selenium in Nutrition. Revised Edition. Washington, DC: The National Academies Press.

Stoffaneller, R., & Morse, N. L. (2015). A review of dietary selenium intake and selenium status in Europe and the Middle East. Nutrients, 7(3), 1494–1537.

Zou, K., Liu, G., Wu, T. & Du, L. (2009). Selenium for preventing Kashin-Beck osteoarthropathy in children: a meta-analysis. Osteoarthritis Cartilage, 17(2):144-151.

The information contained in this review article is not intended as medical advice and should not be construed as such.

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