Effect of Vitamin a (Va) Supplementation on Retinopathy of Prematurity (Rop) in Very Low Birth Weight (Vlbw) Infants

Papagaroufalis, C; Spyropoulos, George; Stamocosta, E; Megreli, Ch; Xanthou, M

doi:10.1203/00006450-199211000-00076

Cited by 2 publications

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“…In this systematic review and meta-analysis of 221 trials that assessed 44 perinatal interventions, we found with moderate certainty that antenatal corticosteroids for lung maturation (small decrease) and indomethacin prophylaxis (moderate decrease) were associated with reduced risk of sIVH in preterm neonates. We also found low certainty evidence that volume-targeted ventilation (large decrease), early ESAs (moderate decrease), and prophylactic ethamsylate (moderate decrease) were associated with lower risk of sIVH, whereas UCM (moderate increase) were associated with higher risk of sIVH in preterm neonates.…”

Section: Discussionmentioning

confidence: 93%

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Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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ImportanceInterventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.ObjectiveTo evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.Data SourcesMEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.Study SelectionRandomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.Data Extraction and SynthesisTwo co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.Main Outcomes and MeasuresThe 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.ResultsA total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], −1% [95% CI, −2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, −5% [95% CI, −8% to −3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, −9% [95% CI, −13% to −5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, −3% [95% CI, −4% to −1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, −4% [95% CI, −7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, −30 [95% CI, −368 to −16]).Conclusions and RelevanceResults of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

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Section: Discussionmentioning

confidence: 93%

“…We further determined the eligibility of 395 short-listed articles and excluded 174 articles for the reasons shown in eAppendix 4 in Supplement 1. A total of 221 RCTs were included in the final sample . These trials evaluated 44 interventions, which included 6 antenatal, 6 delivery room, and 32 neonatal interventions.…”

Section: Resultsmentioning

confidence: 99%

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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“…Vitamin A is thought to be important for regulation of normal lung development (7)(8)(9)(10)(11)(12)(13). Its deficiency in early life results in pulmonary fibrosis in laboratory animals (7)(8)(9)14) and is postulated to result in a greater risk of chronic lung disease for preterm in-fants (15)(16)(17). If the increased serum retinol observed with corticosteroids in our previous studies was due to increased metabolism of liver stores with ultimately an increase in lung parenchymal concentrations, a potential mechanism for how steroids affect chronic lung disease could be postulated.…”

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confidence: 99%

The Effect of Glucocorticosteroids on Serum, Liver, and Lung Vitamin A and Retinyl Ester Concentrations

Georgieff,

Radmer,

Sowell

et al. 1991

J. pediatr. gastroenterol. nutr.

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SummaryVitamin A and its active metabolites are important factors in promoting normal respiratory epithelial differentiation and growth. Glucocorticoids, often used to treat chronic lung diseases in infancy and childhood, are known to increase serum retinol concentrations. To determine the effects of exogenous steroids on serum retinol and retinal‐binding protein concentrations (as well as on liver and lung total vitamin A, retinol, and retinyl ester concentrations), 32 weanling Sprague‐Dawley rats were divided into four equal experimental groups. Eight animals were vitamin A sufficient and received 7 days of intraperitoneal dexamethasone at 0.5 mg/kg/day (group SD), 8 were vitamin A sufficient and received placebo (group SP), 8 were made vitamin A deficient and subsequently received dexamethasone (group DD), and 8 were vitamin A deficient and received placebo (group DP). Dexamethasone increased serum retinol concentrations in the SD group (2.27 ± 0.20 μmol/L) when compared with control (SP, 1.64 ± 0.46 n,mol/L, p < 0.001) as well as with pretreatment baseline values (1.21 ± 0.23 μmol/L, p < 0.001). Lung total vitamin A, retinol, and individual retinyl esters were depleted by 56 ± 19% in the SD group, whereas liver values were depleted by 36 ± 23%. In the vitamin A‐sufficient groups the relative percentages of four major retinyl esters (palmitate, stearate, oleate, and linoleate) did not change in either tissue after steroid exposure. The vitamin A‐deficient groups had no detectable tissue vitamin A, and dexamethasone did not increase serum retinol concentrations in the DD group. Serum retinol‐binding protein concentrations were significantly higher in both steroid‐treated groups when compared with control. Dexamethasone increases serum retinol and retinol‐binding protein concentrations in vitamin A sufficient rats, apparently at the expense of both lung and liver total vitamin A, retinol, and retinyl ester concentrations. We speculate that the liver and lungs are two sources for the increase in serum retinol reported with glucocorticosteroids.

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Effect of Vitamin a (Va) Supplementation on Retinopathy of Prematurity (Rop) in Very Low Birth Weight (Vlbw) Infants

Cited by 2 publications

References 0 publications

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

The Effect of Glucocorticosteroids on Serum, Liver, and Lung Vitamin A and Retinyl Ester Concentrations

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