Neonatal Clinical Care Unit and
Neonatal Clinical Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia.
Pediatrics. 2021 Jan;147(1). doi: 10.1542/peds.2020-009985. Epub 2020 Dec 18.
Evidence suggests that intramuscular vitamin A reduces the risk of bronchopulmonary dysplasia (BPD) in preterm infants. Our objective was to compare enteral water-soluble vitamin A with placebo supplementation to reduce the severity of BPD in extremely preterm infants.
We conducted a double-blind randomized controlled trial in infants <28 weeks' gestation who were to receive either enteral water-soluble vitamin A (5000 IU per day) or a placebo. Supplementation was started within 24 hours of introduction of feeds and continued until 34 weeks' postmenstrual age (PMA). The primary outcome was the severity of BPD, assessed by using the right shift of the pulse oximeter saturation versus the inspired oxygen pressure curve.
A total of 188 infants were randomly assigned. The mean ± SD birth weight (852 ± 201 vs 852 ± 211 g) and gestation (25.8 ± 1.49 vs 26.0 ± 1.39 weeks) were comparable between the vitamin A and placebo groups. There was no difference in the right shift (median [25th-75th percentiles]) of the pulse oximeter saturation versus inspired oxygen pressure curve (in kilopascals) between the vitamin A (11.1 [9.5-13.7]) and placebo groups (10.7 [9.5-13.1]) ( = .73). Enteral vitamin A did not affect diagnosis of BPD or other clinical outcomes. Plasma retinol levels were significantly higher in the vitamin A group versus the placebo group on day 28 and at 34 weeks' PMA.
Enteral water-soluble vitamin A supplementation improves plasma retinol levels in extremely preterm infants but does not reduce the severity of BPD.
有证据表明，肌内注射维生素 A 可降低早产儿患支气管肺发育不良（BPD）的风险。我们的目的是比较肠内水溶性维生素 A 与安慰剂补充剂，以降低极早产儿患 BPD 的严重程度。
我们对胎龄<28 周、需要接受肠内水溶性维生素 A（每天 5000IU）或安慰剂的婴儿进行了一项双盲随机对照试验。补充剂在开始喂养后 24 小时内开始使用，并持续至孕后 34 周（PMA）。主要结局是通过脉搏血氧饱和度与吸入氧压曲线的右移来评估 BPD 的严重程度。
共有 188 名婴儿被随机分配。两组间的平均出生体重（852±201 与 852±211 g）和胎龄（25.8±1.49 与 26.0±1.39 周）相当。两组间脉搏血氧饱和度与吸入氧压曲线的右移（千帕）无差异（中位数[25 至 75 百分位数]），维生素 A 组为 11.1[9.5-13.7]，安慰剂组为 10.7[9.5-13.1]（=0.73）。肠内维生素 A 补充剂对 BPD 的诊断或其他临床结局没有影响。与安慰剂组相比，维生素 A 组在第 28 天和 34 周 PMA 时的血浆视黄醇水平显著升高。
肠内水溶性维生素 A 补充剂可提高极早产儿的血浆视黄醇水平，但不能降低 BPD 的严重程度。
