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Intramuscular Followed by Oral Vitamin A Supplementation in Neonates with Birth Weight from 750 to 1250 g: A

S Giridhar1, Jogender Kumar1, Savita Verma Attri1

  • 1Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.

Indian Journal of Clinical Biochemistry : IJCB
|April 1, 2020
PubMed

Insights

A new vitamin A supplementation (VAS) regimen, starting with intramuscular (IM) injections and followed by oral doses, effectively prevents vitamin A deficiency in very low birth weight (VLBW) neonates. This practical approach significantly improves plasma retinol levels in these vulnerable infants.

Area of Science:

  • Neonatal Medicine
  • Nutritional Science
  • Pediatric Health

Background:

  • Vitamin A deficiency is prevalent in very low birth weight (VLBW) neonates.
  • Intramuscular (IM) vitamin A injections can reduce bronchopulmonary dysplasia but are impractical.
  • Oral vitamin A supplementation has shown limited efficacy in achieving adequate plasma levels.

Purpose of the Study:

  • To evaluate a combined intramuscular (IM) followed by oral vitamin A supplementation schedule.
  • To determine if this regimen can effectively reduce vitamin A deficiency in VLBW infants.
  • To assess plasma retinol levels in VLBW neonates receiving the combined supplementation.

Main Methods:

  • A blinded, randomized controlled trial was conducted in a level III neonatal unit.
  • VLBW neonates (750-1250g) received either vitamin A supplementation (VAS) or placebo.
  • VAS group received IM vitamin A followed by oral doses for 28 days; primary outcome was vitamin A deficiency on day 28.

Main Results:

  • Over 90% of enrolled VLBW neonates were vitamin A deficient at baseline.
  • The incidence of vitamin A deficiency on day 28 was significantly lower in the VAS group (4%) compared to placebo (61%) (p < 0.001).
  • Median plasma retinol levels were significantly higher in the VAS group compared to placebo (489 vs. 184 μg/L, p < 0.001).

Conclusions:

  • A combined IM and oral vitamin A supplementation strategy is highly effective.
  • This regimen significantly reduces vitamin A deficiency in VLBW infants.
  • The practical approach improves plasma retinol levels, addressing a critical nutritional need in VLBW neonates.

Keywords:
Bronchopulmonary dysplasiaNeonateVery low birth weightVitamin A

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