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Use of the intramuscular relative-dose-response test to predict bronchopulmonary dysplasia in premature infants
R D Zachman1, D P Samuels, J M Brand
1Department of Pediatrics, University of Wisconsin-Meriter Perinatal Center, Madison 53715, USA.
Insights
The intramuscular relative dose response (IM-RDR) test on day 1 predicts bronchopulmonary dysplasia (BPD) in premature infants better than single vitamin A measurements. This test may identify infants who would benefit from vitamin A supplementation.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Pediatric Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in premature infants.
- Early prediction of BPD is crucial for timely intervention.
- Vitamin A status is implicated in the development of BPD.
Purpose of the Study:
- To evaluate the efficacy of intramuscular relative dose response (IM-RDR) on day 1 of life in predicting BPD development in premature infants.
- To compare the predictive value of IM-RDR with single measurements of retinol, retinyl palmitate (RP), and retinol binding protein (RBP).
Main Methods:
- Seventy-five premature infants (gestation ≤ 32 weeks) underwent IM-RDR testing on day 1.
- Infants were monitored for BPD development.
- Serum concentrations of retinol, RP, and RBP were measured.
- Retrospective analysis correlated IM-RDR with intraventricular hemorrhage (IVH).
Main Results:
- An IM-RDR ≥ 25% was significantly associated with BPD development (P = 0.025).
- Single day 1 measurements of retinol, RP, and RBP did not differ between infants with and without BPD.
- Higher day-28 retinol concentrations were observed in BPD infants who received postnatal dexamethasone.
- A day-1 RDR ≥ 25% correlated with a higher incidence of IVH.
Conclusions:
- IM-RDR on day 1 is a more accurate predictor of BPD in premature infants than single vitamin A measurements.
- IM-RDR may aid in identifying premature infants who could benefit from vitamin A supplementation to prevent BPD.
- The IM-RDR test shows potential utility in managing vitamin A status in high-risk neonates.
Abstract:
We tested the hypothesis that an intramuscular relative dose response (IM-RDR) on day 1 of life would more accurately predict which premature infants would develop bronchopulmonary dysplasia (BPD) than single measurements of retinol, retinyl palmitate (RP), or retinol binding protein (RBP). Seventy-five premature infants < or = 32 wk gestation had the IM-RDR on day 1 of life. An RDR > or = 25% occurred in 6 of 37 infants who did not develop BPD compared with 15 of 38 infants who developed BPD (P = 0.025). Retinol, RP, and RBP on day 1 were not different between the groups. BPD infants who received postnatal dexamethasone during their hospital course had a higher day-28 baseline retinol concentration (1.19 +/- 0.15 mumol/L) than did the group with no BPD (0.82 +/- 0.06 mumol/L) (P = 0.03). However, the effect of postnatal dexamethasone on serum retinol was biphasic, rising initially, and then declining after 8-12 d. RP values at time 0 and 5 h on day 28 were higher than day 1 values in both infants without BPD and infants with BPD who did not receive dexamethasone. Retrospective analysis also revealed a significant correlation between a day-1 RDR > or = 25% and the incidence of intraventricular hemorrhage in these premature infants. Because the IM-RDR is more helpful in predicting the development of BPD than single serum retinol and RP analyses, this test could be useful in determining which premature infants might benefit from supplemental vitamin A for BPD.