Vitamin A Status of Neonates with Bronchopulmonary Dysplasia

Abstract

ABSTRACT. We prospectively assessed and compared the vitamin A status of two groups of preterm neonates (~1 5 0 0 g birth weight, <32 wk gestation), one who developed clinical and radiographic evidence of bronchopulmonary dysplasia (BPD) (n = lo), and the other (control) who developed no significant lung disease (n = 8). The infants with BPD in this study required prolonged mechanical ventilation and supplemental Oz therapy, and had a higher incidence of cardiorespiratory complications when compared to controls. Their mean plasma vitamin A concentrations were significantly lower than those of controls at four sampling times in the 1st postnatal month. In contrast to the controls, infants with BPD showed a substantial decline in their plasma vitamin A concentrations from the initial values, and a high percentage of individual values of plasma vitamin A concentration in these infants were <lo wg/dl during the 8-wk postnatal period of observation. Delayed establishment of gastrointestinal feeding and a lower vitamin A intake in these infants relative to controls may have accounted for this decline. Our data show that preterm neonates who develop BPD have suboptimal plasma vitamin A concentrations for extended periods of time postnatally. We speculate that the necrotizing bronchiolitis and squamous metaplasia of conducting airways associated with vitamin A deficiency could influence the orderly repair of lung injury in susceptible neonates who are mechanically ventilated and could contribute to the pathophysiology of BPD in these infants. Further studies are needed to determine whether more efficient management of these neonates with regard to their vitamin A nutrition and early achievement of vitamin A sufficiency could result in a decrease in the incidence and severity of BPD. (Pediatr Res 19: 185-189,1985) Abbreviations BPD, bronchopulmonary dysplasia HMD, hyaline membrane disease PDA, patent ductus arteriosus RBP, retinol-binding protein Vitamin A (retinol) influences the orderly growth and differentiation of epithelial cells. Severe vitamin A deficiency results in changes in the tracheobronchial tree that include basal cell

Strategies to minimize lung injury in extremely low birth weight infants

“…Sabe-se, no entanto, que a vitamina A tem efeito antioxidante, e os estudos mostram a redução da incidência de DBP com a reposição dessa vitamina. Prematuros extremos freqüentemente apresentam baixa concentração plasmática de vitamina A 72 , e esta baixa concentração relaciona-se à maior incidência de DBP 73 . 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 .…”

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

“…Vitamin A deficiency occurs often in ELBW infants 1 and may predispose to BPD. 2 Multiple randomized controlled trials and a systematic review have shown that vitamin A supplementation decreases BPD or death. [3][4][5] In a recent multicenter trial conducted by the NICHD Neonatal Research Network, vitamin A supplementation of 5000 IU/dose given intramuscularly (i.m.)…”

Fat-soluble vitamins in breast-fed preterm and term infants

“…The decline in plasma retinol concentration in VLBW infants may be of clinical importance because there is an association between retinol status and the risk for developing chronic lung disease (Hustead et al, 1984;Shenai et al, 1985;Chabra et al, 1994;Inder et al, 1998). The optimal plasma retinol concentration for newborn infants is not known.…”