Ye Yanxiu, Yang Xiaoyan, Zhao Jing, He Jianghua, Xu Xiaoming, Li Jiao, Shi Jing, Mu Dezhi
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China.
Front Pediatr. 2022 Apr 7;10:788409. doi: 10.3389/fped.2022.788409. eCollection 2022.
Vitamin A plays an important role in the development and maintenance of the normal function of organs and systems. Premature infants have low levels of vitamin A, which may be associated with an increased risk of developing disease. This study aimed to evaluate the effects of vitamin A supplementation on short-term morbidity and mortality in very-low-birth-weight (VLBW) infants.
We used PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science to conduct a literature search of studies published before January 1, 2022, to be included in our meta-analysis. The analysis included randomized controlled trials that compared the effects of vitamin A supplementation on VLBW infants (birth weight <1,500 g) and controls given a placebo or no treatment. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.
Twelve randomized controlled trials were included in the meta-analysis, and 2,111 infants were pooled and analyzed. The overall risk of bias was not serious in the included studies. Vitamin A supplementation for reducing the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age seems to be limited [risk ratio (RR):0.85; 95% confidence intervals (CI): 0.70-1.04; 8 studies, 1,595 infants, very-low-certainty evidence], which is different from the previous systematic review. Length of hospital stay (mean difference: -12.67, 95% CI: -23.55 to -1.79; 6 studies, 739 infants, low-certainty evidence), and the incidence of vitamin A deficiency at 28 days postnatal age (RR: 0.08; 95% CI: 0.02-0.38; 3 studies, 358 infants, low-certainty evidence) were reduced in the vitamin A group. Besides, vitamin A supplementation seems to reduce the incidence of periventricular leukomalacia (RR: 0.68; 95% CI: 0.47-0.97; 4 studies, 1,224 infants, low-certainty evidence) and retinopathy of prematurity of any grade (RR: 0.61; 95% CI: 0.48-0.76; 4 studies, 463 infants, moderate-certainty evidence).
There is no sufficient evidence regarding vitamin A supplementation preventing BPD in VLBW infants. Vitamin A supplementation can reduce the incidence of vitamin A deficiency and retinopathy of prematurity of any grade, and may exert an effect of preventing periventricular leukomalacia.
http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020211070.
维生素A在器官和系统正常功能的发育及维持中发挥着重要作用。早产儿维生素A水平较低，这可能与疾病发生风险增加有关。本研究旨在评估补充维生素A对极低出生体重（VLBW）婴儿短期发病率和死亡率的影响。
我们使用PubMed、EMBASE、Cochrane对照试验中央登记库和科学网对2022年1月1日前发表的研究进行文献检索，以纳入我们的荟萃分析。该分析纳入了比较补充维生素A对VLBW婴儿（出生体重<1500g）与给予安慰剂或不进行治疗的对照组影响的随机对照试验。使用推荐分级、评估、制定与评价（GRADE）指南评估证据的确定性。
荟萃分析纳入了12项随机对照试验，共纳入2111名婴儿并进行分析。纳入研究的总体偏倚风险不严重。补充维生素A对降低孕龄36周时支气管肺发育不良（BPD）的发生率似乎有限[风险比（RR）：0.85；95%置信区间（CI）：0.70 - 1.04；8项研究，1595名婴儿，极低确定性证据]，这与之前的系统评价不同。维生素A组的住院时间（平均差：-12.67，95%CI：-23.55至-1.79；6项研究，739名婴儿，低确定性证据）以及出生后28天维生素A缺乏的发生率（RR：0.08；95%CI：0.02 - 0.38；3项研究，358名婴儿，低确定性证据）降低。此外，补充维生素A似乎可降低脑室周围白质软化症的发生率（RR：0.68；95%CI：0.47 - 0.97；4项研究，1224名婴儿，低确定性证据）和任何级别的早产儿视网膜病变的发生率（RR：0.61；95%CI：0.48 - 0.76；4项研究，463名婴儿，中等确定性证据）。
关于补充维生素A预防VLBW婴儿BPD，尚无充分证据。补充维生素A可降低维生素A缺乏和任何级别的早产儿视网膜病变的发生率，并可能对预防脑室周围白质软化症有作用。
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