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Vitamin A status and postnatal dexamethasone treatment in bronchopulmonary dysplasia
J P Shenai1, B G Mellen, F Chytil
1Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA. jayant.shenai@mcmail.vanderbilt.edu
Insights
Vitamin A status is crucial for dexamethasone treatment effectiveness in premature infants with bronchopulmonary dysplasia (BPD). Higher vitamin A levels correlate with better pulmonary outcomes following dexamethasone therapy.
Area of Science:
- Neonatology
- Pulmonology
- Nutritional Science
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Vitamin A (retinol) is vital for lung epithelial repair.
- Dexamethasone is a corticosteroid used to treat BPD in very low birth weight (VLBW) neonates.
Purpose of the Study:
- To investigate if vitamin A status influences the pulmonary response to dexamethasone in VLBW neonates with BPD.
- To analyze changes in plasma vitamin A and retinol-binding protein (RBP) concentrations during dexamethasone treatment.
- To correlate these biochemical changes with clinical pulmonary outcomes.
Main Methods:
- Prospective cohort study of VLBW neonates (<1350g, <31 weeks gestation) with severe BPD requiring significant ventilatory support.
- Administered a 7-day course of dexamethasone with a specific tapering dosage regimen.
- Measured plasma vitamin A and RBP levels at baseline, during, and after treatment; assessed pulmonary response using a composite ventilation score.
Main Results:
- 13 out of 23 infants showed a positive pulmonary response (weaning from oxygen/ventilation).
- Dexamethasone treatment led to a short-term increase in plasma vitamin A and RBP in most infants.
- Higher vitamin A and RBP responses to dexamethasone were observed in infants with positive pulmonary outcomes.
Conclusions:
- Dexamethasone treatment transiently increases plasma vitamin A and RBP, likely via liver mobilization.
- Infant vitamin A status appears to be a significant factor in the pulmonary response to dexamethasone for BPD.
- Gender may also play a role in the efficacy of dexamethasone treatment for BPD.
Objective:
Vitamin A (retinol) plays an important role in epithelial regeneration during recovery from lung injury in bronchopulmonary dysplasia (BPD). Dexamethasone is used in the postnatal treatment of very low birth weight (VLBW) neonates with BPD. To test the hypothesis that the vitamin A status is critical for the beneficial pulmonary response to dexamethasone, we performed a prospective cohort study in which we characterized the changes in plasma concentrations of vitamin A and retinol-binding protein (RBP) in response to dexamethasone, and correlated these changes with the pulmonary outcome.
Methods:
VLBW neonates (birth weight <1350 g, gestational age <31 weeks, postnatal age >10 days), who had presumptive diagnosis of severe BPD and need for high ventilatory support (fraction of inspired oxygen >/=.6, mean airway pressure >/=7 cm H(2)O), were treated with a seven-day course of dexamethasone (.5 mg/kg/d x 2 days,.25 mg/kg/d x 2 days,.1 mg/kg/d x 3 days). Plasma concentrations of vitamin A and RBP were determined sequentially at baseline, and during and after dexamethasone treatment. Pulmonary response to dexamethasone was graded daily using a composite ventilation score. The changes in plasma vitamin A and RBP concentrations were compared between infants with a positive (beneficial) pulmonary response to dexamethasone and those with a negative response.
Results:
Among 23 infants studied, 13 showed a positive pulmonary response to dexamethasone, as indicated by successful weaning from supplemental oxygen and mechanical ventilation, whereas 10 showed a negative response. A significant, yet short-term, increase in plasma concentrations of both vitamin A and RBP was observed in most infants treated with dexamethasone. The plasma vitamin A and RBP responses to dexamethasone tended to be higher in infants with a positive pulmonary response than in those with a negative response. Accounting for gender, a vitamin A response with each 10.0 microg/dL increment in plasma vitamin A concentration was associated with a 60% increase in the odds favoring a positive pulmonary response to dexamethasone.
Conclusion:
Postnatal dexamethasone treatment in VLBW neonates with BPD induces a significant, yet short-term, increase in plasma concentrations of both vitamin A and RBP. This increase probably results from endogenous mobilization of vitamin A from the liver. Our data suggest that the beneficial pulmonary response to dexamethasone in infants with BPD is influenced, at least in part, by the vitamin A status, and that gender plays a role in this response.vitamin A, dexamethasone, bronchopulmonary dysplasia.
