A comparison of three vitamin a dosing regimens in extremely-low-birth-weight infants

Ambalavanan, Namasivayam; Wu, Tzong Jin; Tyson, Jon E.; Kennedy, Kathleen A.; Roane, Claire; Carlo, Waldemar A.

doi:10.1067/mpd.2003.214

Cited by 71 publications

(48 citation statements)

References 18 publications

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“…Um estudo multicêntrico, publicado em 1999 pelo NIH, demonstrou que a suplementação de vitamina A por via intramuscular, na dose de 5.000 UI, três vezes por semana, por 4 semanas, diminui o risco de DBP e aumenta a sobrevida de prematuros 74 . Mais recentemente, Namasivayam et al testaram diferentes doses da vitamina A em prematuros extremos e concluíram que a dose de vitamina A proposta pelo estudo do NIH continua sendo a melhor para diminuir incidência de DBP, sem efeitos colaterais 75 . Portanto, é importante recomendar a reposição da vitamina A para os recém-nascidos prematuros e para as gestantes que apresentam deficiência dessa vitamina, principalmente em áreas carentes de países em desenvolvimento.…”

Section: Antioxidantesunclassified

Strategies to minimize lung injury in extremely low birth weight infants

Suguihara¹,

Lessa²

2005

J Pediatr (Rio J)

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Como citar este artigo: Suguihara C, Lessa AC. Como minimizar a lesão pulmonar no prematuro extremo: propostas. J Pediatr (Rio J). 2005;81(1 Supl):S69-S78. AbstractObjective: To review the main causes of new bronchopulmonary dysplasia and the strategies utilized to decrease its incidence in extremely low birth weight infants. Sources of data:For this review a MEDLINE search from 1966 to October 2004, the Cochrane Database, abstracts from the Society for Pediatric Research and recent meetings on the topic were used. Summary of the findings:The survival of extremely low birth weight infants has increased significantly due to improvement in both scientific knowledge and technology. This improvement in survival has therefore resulted in an increased incidence of bronchopulmonary dysplasia. The characteristics of bronchopulmonary dysplasia in extremely low birth weight infants, the so called new bronchopulmonary dysplasia are quite different from the classic bronchopulmonary dysplasia described by Northway. This new bronchopulmonary dysplasia has a multifactorial etiology, which includes volutrauma, atelectrauma, oxygen toxicity and lung inflammation. Therapy such as prenatal corticosteroids, exogenous surfactant, nasal continuous positive airway pressure, new mechanical ventilation modalities and gentle ventilation have been used in attempts to decrease lung injury severity. Conclusions:In order to prevent lung injury in extremely low birth weight infants, it is necessary to minimize several factors that induce bronchopulmonary dysplasia and to utilize less aggressive therapeutic strategies. In addition to the current therapy used to decrease lung injury, knowledge of these causative factors may create new therapies that may be fundamental in improving the clinical outcomes of premature infants.J Pediatr (Rio J). 2005;81(1 Supl):S69-S78: Extremely low birth weight infant, bronchopulmonary dysplasia, mechanical ventilation. ResumoObjetivo: Apresentar uma revisão das principais causas da nova displasia broncopulmonar e as estratégias utilizadas para diminuir sua incidência nos prematuros extremos. Fontes dos dados:Para essa revisão, pesquisas foram feitas na MEDLINE (1996 a outubro de 2004), no Cochrane Database, em resumos da Society for Pediatric Research e recentes conferências sobre o tema. Síntese dos dados:A tecnologia e os novos conhecimentos científicos têm aumentado significantemente a sobrevida de prematuros extremos. Esse aumento da sobrevida resultou em aumento da incidência de displasia broncopulmonar. Atualmente, a displasia broncopulmonar é mais freqüentemente observada em recém-nascidos < 1.200 g. As características da displasia broncopulmonar nesses prematuros extremos, atualmente chamada de nova displasia broncopulmonar, são bastante diferentes da clássica descrita por Northway. A nova displasia broncopulmonar tem etiologia multifatorial, como volutrauma, atelectrauma, toxicidade ao oxigênio e reação inflamatória. Terapias como corticosteróide pré-natal, surfactante exógeno, pressão aérea positiva co...

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Section: Antioxidantesunclassified

Strategies to minimize lung injury in extremely low birth weight infants

Suguihara¹,

Lessa²

2005

J Pediatr (Rio J)

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“…ELBW infants who were enrolled in a trial of three vitamin A dosing regimens 6 were studied. In this trial, infants who survived to 28 study days had serum collected for retinol dose response, RBP, TTR, and CRP.…”

Section: Methodsmentioning

confidence: 99%

“…3/weeks Â 4 weeks) observed that the higher dose regimen did not decrease biochemical evidence of vitamin A deficiency. 6 Therefore, there is evidence that biochemical evidence of vitamin A (retinol) deficiency persists in some ELBW infants despite vitamin A supplementation, and that the incidence of biochemical deficiency is not reduced by a higher dose in supplemented infants.…”

Section: Introductionmentioning

confidence: 99%

Retinol-Binding Protein, Transthyretin, and C-Reactive Protein in Extremely Low Birth Weight (ELBW) Infants

2005

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BACKGROUND:Vitamin A deficiency reduces retinol binding protein (RBP) but not transthyretin (TTR), while inflammation reduces both RBP and TTR and increases C-reactive protein (CRP), an acute phase reactant. OBJECTIVE:To estimate serum RBP, TTR, and CRP in ELBW infants to test the hypotheses that (a) TTR is a negative acute phase reactant and (b) a higher RBP/TTR ratio or CRP is associated with death/BPD by 36 weeks corrected age. DESIGN/METHODS:Serum RBP, TTR, and CRP were measured in 79 ELBW infants at 28 days. Area under the curve (AUC) of receiver operating characteristic curve analysis evaluated the predictive value of TTR, the RBP/TTR ratio, and CRP for death/BPD at 36 weeks. RESULTS:(1) TTR inversely correlated with CRP (r ¼ À0.45, p<0.0001) consistent with TTR being a negative acute phase reactant. (2) The RBP/TTR ratio predicted death/BPD (AUC 0.68 (CI 0.57 to 0.78)). (3) CRP strongly predicted death/BPD (AUC 0.85 (CI 0.76 to 0.92)), even after exclusion of sepsis. CONCLUSIONS:A higher CRP and RBP/TTR molar ratio on day 28 are associated with death/BPD at 36 weeks in ELBW infants. Lower TTR and maintained RBP/TTR ratios suggest inflammation rather than vitamin A deficiency as the cause for lower serum vitamin A levels in ELBW infants.

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“…Encouraging results have emerged with improved outcome among babies and mothers who were supplemented with vitamin A or other micronutrient combinations. [22][23][24][25][26][27] Simple interventions like vitamin A supplementation during a crucial stage of an infant's life may be beneficial in the long run. Hence, there is a need to seriously examine the role of vitamin A supplementation for LBW babies during the immediate postnatal period.…”

Section: Discussionmentioning

confidence: 99%