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Vitamin A supplementation for extremely low birth weight infants: outcome at 18 to 22 months
Namasivayam Ambalavanan1, Jon E Tyson, Kathleen A Kennedy
1Department of Pediatrics, University of Alabama, Birmingham, Alabama 35249, USA. ambal@uab.edu
Insights
Vitamin A supplementation for extremely low birth weight (ELBW) infants reduced bronchopulmonary dysplasia without increasing mortality or neurodevelopmental impairment at 18-22 months. This study did not have sufficient power for detecting small changes in long-term outcomes.
Area of Science:
- Neonatal Research
- Pediatric Nutrition
- Developmental Pediatrics
Background:
- A previous trial indicated vitamin A supplementation reduces bronchopulmonary dysplasia or death in extremely low birth weight (ELBW) neonates.
- Long-term adverse effects of neonatal interventions require careful evaluation to ensure benefits outweigh risks.
Purpose of the Study:
- To assess the impact of early postnatal vitamin A supplementation on survival without neurodevelopmental impairment in ELBW infants at 18 to 22 months corrected age.
Main Methods:
- Infants from a vitamin A trial were followed up to 18–22 months corrected age.
- Standardized assessments included Bayley Scales (MDI, PDI), visual/hearing screens, and cerebral palsy (CP) evaluation.
- Neurodevelopmental impairment (NDI) was defined by low MDI/PDI, CP, blindness, or hearing loss.
Main Results:
- Of 807 enrolled infants, 687 (85%) had primary outcome data at 18–22 months.
- The rate of NDI or death was 55% in the vitamin A group versus 60% in the control group (RR: 0.94; 95% CI: 0.80–1.07).
- No significant differences were observed in rates of low MDI, low PDI, or CP; no reduction in post-discharge hospitalizations or pulmonary issues was found.
Conclusions:
- Neonatal vitamin A supplementation for ELBW infants effectively reduces bronchopulmonary dysplasia without increasing mortality or neurodevelopmental impairment at 18–22 months corrected age.
- The study was not powered to detect minor changes in long-term developmental outcomes.
Background:
A National Institute of Child Health and Human Development Neonatal Research Network randomized trial showed that vitamin A supplementation reduced bronchopulmonary dysplasia (O2 at 36 weeks' postmenstrual age) or death in extremely low birth weight (ELBW) neonates (relative risk [RR]: 0.89). As with postnatal steroids or other interventions, it is important to ensure that there are no longer-term adverse effects that outweigh neonatal benefits.
Primary Objective:
To determine if vitamin A supplementation in ELBW infants during the first month after birth affects survival without neurodevelopmental impairment at a corrected age of 18 to 22 months.
Design/Methods:
Infants enrolled in the National Institute of Child Health and Human Development vitamin A trial were evaluated at 18 to 22 months by carefully standardized assessments: Bayley Mental Index (MDI) and Psychomotor Index (PDI), visual and hearing screens, and physical examination for cerebral palsy (CP). The medical history was also obtained. Neurodevelopmental impairment (NDI) was predefined as > or =1 of MDI <70, PDI <70, CP, blind in both eyes, or hearing aids in both ears.
Results:
Of 807 enrolled infants, 133 died before and 16 died after discharge. Five hundred seventy-nine (88%) of the 658 remaining infants were followed up. The primary outcome of NDI or death could be determined for 687 of 807 randomized infants (85%). Baseline characteristics and predischarge and postdischarge mortality were comparable in both study groups. NDI or death by 18 to 22 months occurred in 190 of 345 (55%) infants in the vitamin A group and in 204 of 342 (60%) of the control group (RR: 0.94; 95% confidence interval: 0.80-1.07). RRs for low MDI, low PDI, and CP were also <1.0. We found no evidence that neonatal vitamin A supplementation reduces hospitalizations or pulmonary problems after discharge.
Conclusion:
Vitamin A supplementation for ELBW infants reduces bronchopulmonary dysplasia without increasing mortality or neurodevelopmental impairment at 18 to 22 months. However, this study was not powered to evaluate small magnitudes of change in long-term outcomes.
