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Sequential evaluation of plasma retinol-binding protein response to vitamin A administration in very-low-birth-weight
J P Shenai1, M G Rush, R A Parker
1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Insights
Vitamin A deficiency impairs lung healing in premature infants. Measuring plasma retinol-binding protein (RBP) response after vitamin A supplementation can help identify deficiency early in very-low-birth-weight neonates at risk for bronchopulmonary dysplasia.
Area of Science:
- Neonatology
- Nutritional Science
- Pulmonology
Background:
- Vitamin A (retinol) deficiency is linked to poor lung injury healing in very-low-birth-weight (VLBW) neonates.
- Bronchopulmonary dysplasia (BPD) is a significant risk in VLBW infants.
- Early vitamin A supplementation may improve outcomes.
Purpose of the Study:
- To evaluate plasma retinol-binding protein (RBP) response as a dynamic indicator of vitamin A status.
- To assess the utility of RBP response for early detection of vitamin A deficiency in VLBW neonates at risk for BPD.
Main Methods:
- Prospective study of 20 VLBW neonates (<1300g, <30 weeks GA) requiring ventilation.
- Sequential measurement of plasma RBP before and after intramuscular vitamin A (retinyl palmitate) injections on multiple postnatal days.
- Calculation of plasma RBP percentage increase (delta-RBP) to assess vitamin A status.
Main Results:
- A delta-RBP > 8% indicated vitamin A deficiency.
- Plasma vitamin A levels increased to the desired range in both BPD and No BPD groups during supplementation.
- Mean vitamin A intake did not differ between groups.
Conclusions:
- Plasma RBP response following vitamin A administration offers a dynamic measure of vitamin A status.
- This method may aid in the early recognition of vitamin A deficiency in VLBW neonates susceptible to BPD.
Abstract:
Vitamin A (retinol) deficiency is associated with impaired healing from lung injury in very-low-birth-weight (VLBW) neonates susceptible to bronchopulmonary dysplasia (BPD). Vitamin A supplementation from birth may ameliorate this adverse outcome. We hypothesized that plasma retinol-binding protein (RBP) response to vitamin A administration, which provides a dynamic measure to vitamin A status, might be useful for early recognition of vitamin A deficiency in VLBW neonates at risk for BPD. We prospectively studied 20 VLBW neonates (inclusion criteria: birth weight < 1300 g, gestational age < 30 weeks, need for supplemental oxygen and mechanical ventilation for > 24 h after birth) who were eligible to receive vitamin A supplementation. In addition to sequential assessment of vitamin A status, we measured plasma RBP just before and 3 and 6 h after an intramuscular injection of vitamin A (2000 IU/kg retinyl palmitate) on Postnatal Days 1, 7, 15, 21, 29, and 43. The percentage increase in plasma RBP (delta-RBP) was calculated. A high plasma delta-RBP value ( > 8%) is indicative of vitamin A deficiency. Based on pulmonary outcome, the infants were divided into two groups: BPD (n = 12) and No BPD (n = 8). Mean vitamin A intake ranged from 1414 to 2114 IU/kg/day and did not differ between infant groups. Mean plasma vitamin A concentration increased from baseline levels on Postnatal Day 1 to levels within the desired range of 1.05-2.10 mumol/liter (30.0-60.0 micrograms/dl) during supplementation period in both infant groups.(ABSTRACT TRUNCATED AT 250 WORDS)