title: Low plasma retinol concentrations increase the risk of developing bronchopulmonary dysplasia and long-term respiratory disability in very-low-birth-weight infants.
abstract: BACKGROUND
  The effect of inadequate vitamin A during the neonatal period on lung status is still unknown.
  
  
  OBJECTIVE
  We tested the hypothesis that low plasma retinol concentrations during the first month of life are independently associated with bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity at 6 mo gestationally corrected age (ie, the age the infant would be had the pregnancy gone to term).
  
  
  METHODS
  Respiratory outcome information was obtained to 6 mo corrected age for a historical cohort of very-low-birth-weight neonates (<1250 g) who were admitted to intensive care over a 7-y period. Neonates with one or more plasma measurements of retinol concentrations < 0.35 micromol/L (<100 microg/L) on days 1-28 were classified as having low vitamin A. BPD was defined at day 28 by clinical and radiologic criteria and by use of supplemental oxygen at 36 wk postmenstrual age (PMA). Dependence on supplemental oxygen was used to identify long-term respiratory disability at 6 mo corrected age. Multivariate logistic regression analyses were conducted.
  
  
  RESULTS
  Of the 350 study infants, 192 (55%) had low vitamin A status. BPD occurred in 52% of survivors at day 28 (173/331) and at 36 wk PMA (147/285). Fourteen percent (33/244) required oxygen support at 6 mo corrected age. Adjusted odds ratios of BPD with low vitamin A were 3.5 (95% CI: 1.7, 7.2) at day 28 and 1.7 (1.0, 2.7) at 36 wk PMA. At 6 mo corrected age, the adjusted odds ratio was 2.6 (1.1, 6.4) for respiratory disability with low vitamin A.
  
  
  CONCLUSIONS
  Poor vitamin A status during the first month of life significantly increased the risk of developing BPD and long-term respiratory disability.
authors.affiliation: Nutritional Science Program, School of Public Health and Community Medicine, University of Washington, Seattle, USA. spearsk@ba.ars.usda.gov
authors.forename: Karen
authors.initials: K
authors.lastname: Spears
authors.forename: Carrie
authors.initials: C
authors.lastname: Cheney
authors.forename: Joan
authors.initials: J
authors.lastname: Zerzan
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000453:epidemiology; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014801:Vitamin A / Q000097:blood*; D014802:Vitamin A Deficiency / Q000150:complications*
chemical_list: D014801:Vitamin A