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Effect of Enteral Vitamin A on Fecal Calprotectin in Extremely Preterm Infants: A Nested Prospective Observational
Abhijeet A Rakshasbhuvankar1,2,3, J Jane Pillow2,3, Sanjay Keshav Patole1,2
1Neonatal Clinical Care Unit, King Edward Memorial and Perth Children's Hospitals, Perth, Washington, Australia.
Insights
Enteral vitamin A supplementation did not reduce intestinal inflammation markers in extremely preterm infants. Further research with larger sample sizes is needed to confirm these findings on fecal calprotectin levels.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Nutritional Science
Background:
- Vitamin A possesses anti-inflammatory and immune-modulating properties.
- Intestinal inflammation is a significant concern in extremely preterm infants.
- Fecal calprotectin is a validated biomarker for intestinal inflammation.
Purpose of the Study:
- To evaluate the effect of enteral water-soluble vitamin A supplementation on fecal calprotectin levels in extremely preterm infants.
- To determine if vitamin A reduces intestinal inflammation in this vulnerable population.
Main Methods:
- Prospective observational study nested within a randomized, double-blind, placebo-controlled trial.
- Extremely preterm infants received either enteral vitamin A (5,000 IU/day) or placebo for 28 days.
- Fecal calprotectin levels were measured via enzyme-linked immunosorbent assay (ELISA).
Main Results:
- No significant difference in fecal calprotectin levels between vitamin A (152 µg/g) and placebo (179 µg/g) groups (p=0.195).
- Infant characteristics (gestational age, birth weight) and feeding regimens were comparable.
- Two infants in the vitamin A group developed necrotizing enterocolitis versus none in the placebo group; BPD incidence was similar.
Conclusions:
- Enteral vitamin A supplementation did not significantly alter fecal calprotectin levels in extremely preterm infants.
- The study suggests vitamin A may not be effective in reducing intestinal inflammation in this population.
- Larger sample size studies are recommended to confirm these findings.
Background:
Vitamin A has anti-inflammatory and immune-modulating properties. We aimed to assess whether enteral water-soluble vitamin A supplementation in extremely preterm infants decreases fecal calprotectin, a marker of intestinal inflammation.
Methods:
This was a prospective observational study nested in a randomized, double-blind, placebo-controlled clinical trial investigating enteral vitamin A (5,000 IU/day) for reducing the severity of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Fecal calprotectin levels were measured using enzyme-linked immunosorbent assay after 28 days of Vitamin A or placebo supplementation.
Results:
Fecal calprotectin was measured in 66 infants (Vitamin A: 33, Placebo: 33). The mean (standard deviation) gestational age (25.5 [1.55] vs. 25.8 [1.48]; p = 0.341) (week), birth weight (810 [200] vs. 877 [251]; p = 0.240) (gram), and factors influencing fecal calprotectin levels were comparable between the vitamin A versus placebo group infants. All infants were exclusively fed with mother's or donor's human breast milk if mother's milk was unavailable using a standardized feeding regimen and received prophylactic probiotic supplementation. Fecal calprotectin levels (median; 25th-75th centiles) (micrograms/gram of feces) were not significantly different between vitamin A (152; 97-212) and placebo groups (179; 91-313) (p = 0.195). Two infants in the vitamin A group developed definite necrotizing enterocolitis compared to none in the placebo group. Incidence of BPD at 36 weeks postmenstrual age was similar between the groups (vitamin A: 18/33, placebo: 13/33, p = 0.218).
Conclusion:
Enteral supplementation with water-soluble vitamin A did not affect fecal calprotectin levels in extremely preterm infants. Studies with a larger sample size are required to confirm the findings.
