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Early vs delayed vitamin A supplementation in very-low-birth-weight infants
1Department of Nutrition, Children's National Medical Center, Washington, District of Columbia 20010.
Insights
Early vitamin A supplementation significantly reduced bronchopulmonary dysplasia (BPD) in premature infants. Prompt administration and monitoring of vitamin A levels are essential for preventing BPD in high-risk newborns.
Area of Science:
- Neonatology
- Nutritional Science
- Pediatric Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in very-low-birth-weight infants.
- Vitamin A deficiency is common in premature infants and may contribute to BPD development.
Purpose of the Study:
- To investigate if vitamin A adequacy can decrease the incidence of BPD in very-low-birth-weight infants.
- To compare the effects of two different vitamin A supplementation regimens on BPD rates.
Main Methods:
- A randomized trial involving 48 very-low-birth-weight infants (mean birth weight <1000 g, mean gestational age 27 weeks).
- Two groups received vitamin A supplementation: Group I (later start, days 10-14) and Group II (earlier start, days 2-4).
- Serum vitamin A levels were monitored, and supplementation adjusted based on parenteral and enteral nutrition protocols.
Main Results:
- A significantly smaller proportion of infants in Group II (earlier supplementation) developed BPD at 36 weeks' gestational age compared to Group I.
- While oxygen support at 28 days was similar, Group II showed a trend toward less ventilatory support.
- Neonatal intensive care unit (NICU) stay was significantly reduced in Group II (60 days) compared to Group I (81 days).
Conclusions:
- Early administration of vitamin A supplementation is crucial for premature infants at risk of BPD.
- Monitoring plasma vitamin A levels is essential to ensure adequacy and optimize treatment.
- This strategy can reduce BPD incidence and shorten NICU stays for vulnerable infants.
Abstract:
The purpose of this trial was to test the hypothesis that vitamin A adequacy may decrease the incidence of bronchopulmonary dysplasia (BPD) in very-low-birth-weight infants. Serum vitamin A levels were measured and the effects of two regimens of vitamin A supplementation on the incidence of BPD were compared. There were 24 infants in each of two groups with a mean birth weight less than 1000 g, a mean gestational age of 27 weeks, and similar sexual and racial mixes. In group I, vitamin A levels were measured after 1 week of parenteral nutrition and, if low, the infant was given a 2000-IU supplement intramuscularly three times a week, beginning on the 10th to 14th day of life. In group II, the same supplementation was begun on the second to fourth day of life. In both groups, when enteral feedings reached 60 kcal/kg per day, 2500 IU/d vitamin A was given orally. The incidence of oxygen support at 28 days was similar in both groups, although in group II there was a trend toward less vigorous ventilatory support. chi 2 analysis showed that a significantly smaller proportion of infants in group II had BPD at 36 weeks' gestational age than in group I. Length of neonatal intensive care unit stay was significantly reduced from 81 to 60 days. We conclude that vitamin A supplementation should be administered early to small, premature infants who are at risk for BPD and that monitoring of plasma levels is essential.