Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis

PLoS ONE
Q1
Nov 2018
Citations:37
Influential Citations:1
Systematic Reviews / Meta-Analyses
87
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Methods
Four randomized controlled trials enrolling extremely low birth weight infants (<1,000 g) in NICUs in the United States, United Kingdom, and Thailand; total participants: 1,011; study designs: randomized controlled trials; blinding reported.
Intervention
Vitamin A supplementation regimens varied across trials: Tyson 1999 – intramuscular 5,000 IU, 3×/week for 4 weeks; Wardle 2001 – oral 5,000 IU/kg daily until day 28 (with 23 IU/kg/d vitamin A added to Intralipid when on parenteral nutrition); Kiatchoosakun 2014 – intramuscular 5,000 IU, 3×/week for 4 weeks; Mactier 2012 – additional 10,000 IU intramuscular vitamin A 3×/week starting from day 2 for at least 2 weeks or until oral feeding established.
Results
Vitamin A supplementation reduced oxygen dependency at postmenstrual age 36 weeks in survivors (RR 0.88; 95% CI 0.77–0.99; 4 trials, 841 infants; moderate certainty). No significant reductions were observed for neonatal death, oxygen use at 28 days in survivors, duration of mechanical ventilation, intraventricular hemorrhage, retinopathy of prematurity, or necrotizing enterocolitis. Length of hospital stay was reduced in Kiatchoosakun 2014 (MD −49.9; 95% CI −88.78 to −11.02; 20 infants; low certainty). Conclusion: VA supplementation in ELBWIs may decrease oxygen dependency at 36 weeks PMA, but effects on other outcomes are limited and vary by dosing and delivery method; more trials, especially with oral regimens, are needed to define optimal dosing and delivery.
Limitations
Small number of trials (4) with heterogeneous vitamin A dosing routes and schedules; oldest trial (Tyson 1999) may limit applicability to current NICU care; incomplete data for some outcomes; reliance on author-provided data for some trials; generalizability to current practice remains uncertain.

Abstract

Background Vitamin A (VA) supplementation reduces the risk of developing bronchopulmonary dysplasia (BPD). However, a previous meta-analysis showed that VA had minimal efficacy for preventing BPD in very low birth weight infants (VLBWIs). Aims To elu...