A comparison of three vitamin A dosing regimens in extremely-low-birth-weight infants.
OBJECTIVE
Vitamin A supplementation reduces bronchopulmonary dysplasia (BPD)/death in extremely low birth weight neonates. It was hypothesized that compared with the standard regimen of 5000 IU 3 times per week for 4 weeks, (1) a higher dose (10,000 IU 3 x per week) would increase serum retinol and retinol binding protein (RBP) and lower relative dose responses (RDR), and (2) once-per-week dosing (15,000 IU once per week) would lead to equivalent levels, RBP, and RDR.


METHODS
Extremely low birth weight neonates (n = 120) receiving O(2)/mechanical ventilation at 24 hours were randomly assigned to (1) standard, (2) higher dose, or (3) once-per-week regimens. Measures of vitamin A deficiency were serum retinol <20 microg/dL, RBP <2.5 mg/dL, and/or RDR >10% on day 28. BPD was defined as O(2)/mechanical ventilation at 36 weeks' postmenstrual age.


RESULTS
Groups were similar at enrollment (median gestational age, 25 weeks; birth weight, 689 g). Possible toxicity was seen in <5%. The higher dose regimen did not increase retinol or RBP, decrease RDR, or improve outcomes. Infants in the once-per-week regimen had lower retinol levels and higher RDR without an effect on outcomes.


CONCLUSIONS
Compared with the standard regimen, once-per-week dosing worsened, and higher doses did not reduce, vitamin A deficiency. Therefore, the standard regimen is recommended.
Ambalavanan
Namasivayam
N
Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA. ambal@uab.edu
Wu
Tzong-Jin
TJ
Tyson
Jon E
JE
Kennedy
Kathleen A
KA
Roane
Claire
C
Carlo
Waldemar A
WA
D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D008297:Male; D012177:Retinol-Binding Proteins / Q000032:analysis; D014801:Vitamin A / Q000008:administration & dosage* / Q000097:blood
D012177:Retinol-Binding Proteins; D014801:Vitamin A