Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis
What this study found
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,…
- Study & population
- 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…
- Key limitation
- 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.
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Open PDFOriginal 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 elucidate the effects of VA supplementation for BPD prevention in extremely low birth weight infants (ELBWIs). Study design This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered the protocol on PROSPERO, the international prospective registry of systematic reviews (registration number: CRD42016050887). We searched the following five databases: CINAHL, CENTRAL, EMBASE, MEDLINE, and PubMed; screened the reference lists of retrieved articles to identify randomized controlled trials (RCTs); and assessed the Cochrane Risk of Bias for each study. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results Four studies (total, 1,011 infants) were included. VA was administered intramuscularly in 3 studies and orally in 1 study. VA supplementation for ELBWIs had benefited oxygen dependency at the postmenstrual age of 36 weeks in survivors (pooled risk ratio, 0.88; 95% confidence intervals (CI), 0.77–0.99; 4 trials, 841 infants, moderate certainty of evidence), which is similar to the meta-analysis in VLBWIs. Length of hospital stay was reduced in the VA group (mean difference, −49.9; 95% CI, −88.78 to −11.02; 1 trial, 20 infants, low certainty of evidence). The meta-analysis showed no reduction in the risk of neonatal death, oxygen use at 28 days in survivors, duration of mechanical ventilation, intraventricular hemorrhage, retinopathy in prematurity, and necrotizing enterocolitis. Conclusions VA supplementation for ELBWIs is potentially effective in decreasing oxygen dependency at the postmenstrual age of 36 weeks.