Neonatal Clinical Care Unit, King Edward Memorial and Perth Children's Hospitals, Perth, Washington, Australia.
Paediatric Division, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Washington, Australia.
Neonatology. 2021;118(6):720-726. doi: 10.1159/000518680. Epub 2021 Sep 10.
Vitamin A has anti-inflammatory and immune-modulating properties. We aimed to assess whether enteral water-soluble vitamin A supplementation in extremely preterm infants decreases fecal calprotectin, a marker of intestinal inflammation.
This was a prospective observational study nested in a randomized, double-blind, placebo-controlled clinical trial investigating enteral vitamin A (5,000 IU/day) for reducing the severity of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Fecal calprotectin levels were measured using enzyme-linked immunosorbent assay after 28 days of Vitamin A or placebo supplementation.
Fecal calprotectin was measured in 66 infants (Vitamin A: 33, Placebo: 33). The mean (standard deviation) gestational age (25.5 [1.55] vs. 25.8 [1.48]; p = 0.341) (week), birth weight (810 [200] vs. 877 [251]; p = 0.240) (gram), and factors influencing fecal calprotectin levels were comparable between the vitamin A versus placebo group infants. All infants were exclusively fed with mother's or donor's human breast milk if mother's milk was unavailable using a standardized feeding regimen and received prophylactic probiotic supplementation. Fecal calprotectin levels (median; 25th-75th centiles) (micrograms/gram of feces) were not significantly different between vitamin A (152; 97-212) and placebo groups (179; 91-313) (p = 0.195). Two infants in the vitamin A group developed definite necrotizing enterocolitis compared to none in the placebo group. Incidence of BPD at 36 weeks postmenstrual age was similar between the groups (vitamin A: 18/33, placebo: 13/33, p = 0.218).
Enteral supplementation with water-soluble vitamin A did not affect fecal calprotectin levels in extremely preterm infants. Studies with a larger sample size are required to confirm the findings.
维生素 A 具有抗炎和免疫调节作用。我们旨在评估极低出生体重儿肠内水溶性维生素 A 补充是否会降低粪便钙卫蛋白（一种肠道炎症的标志物）。
这是一项前瞻性观察性研究，嵌套在一项随机、双盲、安慰剂对照的临床试验中，该试验研究了肠内给予维生素 A（5000IU/天）是否可以降低极早产儿支气管肺发育不良（BPD）的严重程度。在接受维生素 A 或安慰剂补充 28 天后，使用酶联免疫吸附试验测量粪便钙卫蛋白水平。
在 66 名婴儿（维生素 A：33 名，安慰剂：33 名）中测量了粪便钙卫蛋白。两组的平均（标准差）胎龄（25.5[1.55] vs. 25.8[1.48]；p=0.341）（周）、出生体重（810[200] vs. 877[251]；p=0.240）（克）和影响粪便钙卫蛋白水平的因素相似。如果母亲的乳汁不可用，所有婴儿都通过标准化喂养方案用母亲或捐赠者的人乳进行喂养，并接受预防性益生菌补充。维生素 A 组和安慰剂组的粪便钙卫蛋白水平（中位数；25 至 75 百分位数）（粪便中微克/克）无显著差异（152；97-212 与 179；91-313）（p=0.195）。与安慰剂组相比，维生素 A 组中有 2 名婴儿发生了明确的坏死性小肠结肠炎，而安慰剂组中没有。两组在 36 周龄时的 BPD 发生率相似（维生素 A：18/33，安慰剂：13/33，p=0.218）。
极低出生体重儿肠内补充水溶性维生素 A 不会影响粪便钙卫蛋白水平。需要更大样本量的研究来证实这些发现。
