ABSTRACT
Preterm infants often have abnormally low serum vitamin A concentrations. Persistence
of vitamin A deficiency for a prolonged postnatal period may contribute to the development
of bronchopulmonary dysplasia. We retrospectively analyzed data from 22 infants with
birthweight < 1250 g who had hyaline membrane disease requiring mechanical ventilation
with oxygen and in whom serum vitamin A concentrations had been measured at the onset
of enteral feeding and every 2 weeks thereafter. Thirteen infants (low serum vitamin
A group) had one or more serum vitamin A concentrations < 11 mcg/dL at > 10 days of
age. In 9 infants (higher serum vitamin A group) all serum vitamin A concentrations
were > 11 mcg/dL at > 10 days of age. Mean birth-weight, mean gestational age, sex,
race, incidence of antenatal maternal glucocorticoid treatment and ventilatory support
on the first day of life were similar for the two groups. Severe bronchopulmonary
dysplasia was defined as characteristic radiographic changes and either discharge
from the hospital with supplemental oxygen or death from respiratory failure at >
28 days of age following mechanical ventilation with oxygen since birth. The incidence
of severe bronchopulmonary dysplasia was significantly higher in the low serum vitamin
A group (11/13, 3 deaths vs. 1/9, no deaths; p=0.001). The incidence of pulmonary
air leak, the number of ventilator days, the number of days of postnatal glucocorticoid
treatment for chronic lung disease, the number of episodes of suspected sepsis and
the number of days of antibiotic treatment also were higher in the low serum vitamin
A group. Low serum vitamin A group infants were older at the onset of enteral feeding
(21 days vs. 8 days; p = 0.001) and during feeding their average daily enteral intake
of vitamin A was lower (713 IU vs. 1255 IU; p = 0.001) when compared with infants
in the higher serum vitamin A group. Our retrospective analysis of data from these
infants confirms earlier reports from other workers that persistent marked vitamin
A deficiency in very low birthweight infants is associated with a high incidence of
severe bronchopulmonary dysplasia, delayed onset of enteral feeding and low enteral
intake of vitamin A.
