1 Neonatal Immunology Laboratory, UOC Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
2 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
Int J Immunopathol Pharmacol. 2018 Mar-Dec;32:2058738418820484. doi: 10.1177/2058738418820484.
Retinol palmitate oral administration is convenient, but it is difficult to assess/monitor its nutritional status in preterm infants and literature is controversial about the administration route and the effectiveness of vitamin A supplementation. We primarily evaluated retinol plasma levels to assess the vitamin A nutritional status in preterm infants (<1500 g; 32 weeks) after 28 days of oral supplementation (3000 IU/kg/day, retinol palmitate drops), in addition to vitamin A standard amount as suggested by European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines. We then observed the rate of typical preterm pathologies in the supplemented group (31 newborns) and in 10 matching preterm infants, hospitalized in neonatal intensive care unit (NICU) in the same period, who received neither vitamin A supplementation nor parents allowed plasma sampling. Oral integration resulted in constant retinol plasma concentration around the desired level of 200 ng/mL, but without statistical increase during the study period. Due to the complexity of vitamin A metabolism and the immaturity of preterm infant's organs, retinol supplementation may had first saturated other needy tissues; therefore, plasmatic measures may not be consistent with improved global vitamin A body distribution. Therefore, achieving a constant retinol concentration is a valuable result and supportive for oral administration: decreasing levels, even after parenteral/enteral supplementation, were reported in the literature. In spite of favourable trend and no adverse events, we did not report statistical difference in co-morbidities. This investigation confirms the necessity to perform further trials in preterm newborns, to find an index reflecting the complex nutritional retinol status after oral administration of vitamin A, highlighting its effectiveness/tolerability in correlated preterm infant's pathologies.
棕榈酸视黄醇口服给药方便，但难以评估/监测早产儿的营养状况，且文献对视黄醇补充的给药途径和有效性存在争议。我们主要评估了早产儿(<1500g；32 周)在口服补充 28 天后的视黄醇血浆水平，以评估其维生素 A 营养状况(每天 3000IU/kg，视黄醇棕榈酸滴剂)，同时还根据欧洲儿科胃肠病学、肝病学和营养学会 (ESPGHAN) 指南补充了维生素 A 的标准量。然后，我们观察了补充组(31 名新生儿)和同期在新生儿重症监护病房(NICU)住院的 10 名匹配早产儿的典型早产儿疾病发生率，这些早产儿既未接受维生素 A 补充，也未允许进行血浆取样。口服给药导致视黄醇血浆浓度持续稳定在 200ng/mL 左右，但在研究期间没有统计学上的增加。由于维生素 A 代谢的复杂性和早产儿器官的不成熟性，视黄醇补充可能首先满足了其他需要的组织；因此，血浆测量可能与改善全身维生素 A 分布不一致。因此，实现恒定的视黄醇浓度是一个有价值的结果，并支持口服给药：文献中报道了即使在肠外/肠内补充后，浓度也会下降。尽管有良好的趋势且没有不良反应，但我们没有报告在合并症方面有统计学差异。本研究证实了在早产儿中进一步开展试验的必要性，以找到反映口服维生素 A 后复杂营养视黄醇状况的指标，突出其在相关早产儿疾病中的有效性/耐受性。
