Princess Royal Maternity, Glasgow, Scotland, UK.
J Pediatr. 2012 Jun;160(6):954-9.e1. doi: 10.1016/j.jpeds.2011.12.013. Epub 2012 Jan 28.
Preterm infants show reduced retinal sensitivity at term corrected age compared with newborn term infants. We tested the hypothesis that retinal sensitivity in preterm infants is improved by early, high-dose vitamin A.
We report a double-blind, randomized controlled trial of infants <32 weeks' gestation and/or <1501 g birth weight. Supplemented infants received additional intramuscular vitamin A 10 000 IU 3 times weekly from day 2 for a minimum of 2 weeks or until establishment of oral feeding. Hepatic stores were assessed by relative dose response (RDR). The primary outcome measure was cone-corrected dark-adapted retinal rod sensitivity measured by electroretinogram at 36 weeks' postmenstrual age (PMA).
Eighty-nine infants (42 supplemented and 47 controls) were recruited. Plasma retinol was higher in supplemented infants at 7 and 28 days (median, 1.0 vs 0.5 μmol/L and 0.7 vs 0.6 μmol/L; P < .001 and .03, respectively). Neither plasma retinol nor RDR differed between groups at 36 weeks' PMA. Retinal sensitivity was greater in supplemented infants (-0.81 vs -0.61 log cd • s • m(-2); P < .03) and was not related to RDR.
Early high-dose intramuscular vitamin A supplementation for infants at risk of retinopathy of prematurity improves retinal function at 36 weeks' PMA.
与足月新生儿相比，早产儿在矫正胎龄足月时的视网膜敏感性降低。我们检验了这样一个假设，即早产儿的视网膜敏感性可以通过早期给予高剂量维生素 A 得到改善。
我们报告了一项针对胎龄<32 周和/或出生体重<1501 克的婴儿的双盲、随机对照试验。补充组婴儿在出生后第 2 天开始每周接受 3 次肌内注射维生素 A 10000IU，至少 2 周或直至建立口服喂养。通过相对剂量反应（RDR）评估肝内储存量。主要观察指标是通过视网膜电图在矫正胎龄 36 周时测量的锥细胞校正暗适应视网膜杆状细胞敏感性。
共招募了 89 名婴儿（42 名补充组和 47 名对照组）。补充组婴儿在第 7 天和第 28 天的血浆视黄醇水平更高（中位数分别为 1.0μmol/L 对 0.5μmol/L 和 0.7μmol/L 对 0.6μmol/L；P<0.001 和 P<0.03）。两组在矫正胎龄 36 周时的血浆视黄醇或 RDR 均无差异。补充组婴儿的视网膜敏感性更高（-0.81 对-0.61logcd•s•m(-2)；P<0.03），且与 RDR 无关。
对有发生早产儿视网膜病变风险的婴儿进行早期大剂量肌内注射维生素 A 补充可改善矫正胎龄 36 周时的视网膜功能。
