Vitamin A supplementation for prevention of bronchopulmonary dysplasia in very-low-birth-weight premature Thai infants: a randomized trial.

Background: Bronchopulmonary dysplasia (BPD) is one of the most significant complications among very-low-birth-weight (VLBW) premature infants. Vitamin A deficiency increases the risk of BPD in VLBW infants. Objective: To assess the effect of vitamin A supplementation for prevention of bronchopulmonary dysplasia in VLBW premature Thai infants. Study design: Randomized control trial. Material and Method: Eighty premature infants weighing <1,500 g who received mechanical ventilation or oxygen supplementation at 24 hours of age-admitted to Neonatal units of Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand-were assigned to receive either intramuscular vitaminA 5,000 IU 3 times/week (treatment group) or sham procedure (control group) for four weeks. Serum vitamin A levels were measured before and after administration of the vitamin A. Results: The baseline of mean serum vitamin A levels were similar in both groups. The mean serum level of vitamin A was significantly higher in the vitamin A supplemented infants than in the control infants on day 7 (1.41+0.48 vs. 0.92+0.38 μmol/ L, p<0.001), day 14 (1.48+0.90 vs. 0.96+0.36 μmol/L, p = 0.001) and day 28 (1.42+0.63 vs. 0.76+0.30 μmol/L, p<0.001) after vitamin A supplementation. None of the infants in the vitamin A supplemented group, compared to 5% of the infants in the control group, had vitamin A level <0.35 μmol/L, (indicating severe vitamin A deficiency) at 28 days. Fewer of the premature infants in the vitamin A supplemented group required oxygen supplementation at 36 weeks postmenstrual age than in the control group albeit not statistically significant (22.5 vs. 35% relative risk 0.71; 95% CI 0.40-1.26; p = 0.21). Supplementation with vitamin A was also associated with a significant reduction in the duration of intubation (10.8+3.1 days vitamin A supplemented group vs. 26.1+6.4 days control group, p = 0.03), days on oxygen therapy (29.8+5.1 days vitamin A supplemented group vs. 58.2+9.1 days control group, p = 0.01) and length of hospital stay (61.9+4.2 days vitamin A supplemented group vs. 88.3+7.2 days control group, p = 0.002). Conclusion: The dose of vitamin A used in this study reduced biochemical evidence of vitamin A deficiency and, without complications, resulted in reducing duration of intubation, days of oxygen therapy, and length of hospital stay in premature infants suffering VLBW. Keywords: Bronchopulmonary dysplasia, Premature infants, Vitamin A