Inder T E, Graham P J, Winterbourn C C, Austin N C, Darlow B A
Department of Paediatrics, Christchurch Hospital and Clinical School of Medicine, New Zealand.
Early Hum Dev. 1998 Sep;52(2):155-68. doi: 10.1016/s0378-3782(98)00026-7.
To examine the association between plasma vitamin A levels and outcome measures in very low birthweight (VLBW) infants, including meta-analysis of all observational studies.
A prospective observational longitudinal study of plasma vitamin A levels measured in the cord blood; maternal blood in the first 48 h after delivery; and the infants' blood at 48 h, 7 days and 28 days of age and correlated with antenatal and postnatal events. A meta-analysis of all published observational studies on the association of vitamin A with respiratory outcome in the VLBW infant was undertaken.
Fifty-seven infants (88% of all eligible) VLBW infants (< 1500 g) admitted from January through October 1993 to one of two regional neonatal intensive care units in the South Island of New Zealand.
Exposure to antenatal steroids led to a significant increase in infant cord plasma vitamin A levels (P = 0.003), but no influence on infant plasma vitamin A levels at any other time. Exposure to postnatal steroids produced a significant rise in infant plasma vitamin A levels between 7 and 28 days (P = 0.008). After controlling for gestational age, antenatal and postnatal steroid exposure, low vitamin A levels at 48 h increased the risk of developing chronic lung disease (odds ratio for 50 microg/l decrease: 2.04, 95% CI 1.19-5.77) and bronchopulmonary dysplasia (odds ratio 1.96, 95% CI 1.14-6.87). On combining our results in meta-analysis with those of other published prospective observational studies, infants with chronic lung disease had lower plasma vitamin A levels at all times.
Our results support an association between low plasma vitamin A levels and adverse outcome in the VLBW infant.
研究极低出生体重（VLBW）婴儿血浆维生素A水平与预后指标之间的关联，包括对所有观察性研究进行荟萃分析。
一项前瞻性观察性纵向研究，测定脐血、产后48小时内的母血以及婴儿出生后48小时、7天和28天的血浆维生素A水平，并将其与产前和产后事件相关联。对所有已发表的关于维生素A与VLBW婴儿呼吸结局关联的观察性研究进行荟萃分析。
1993年1月至10月间入住新西兰南岛两个地区新生儿重症监护病房之一的57例VLBW婴儿（<1500g，占所有符合条件婴儿的88%）。
产前使用类固醇导致婴儿脐血浆维生素A水平显著升高（P = 0.003），但对其他任何时间的婴儿血浆维生素A水平均无影响。产后使用类固醇使婴儿血浆维生素A水平在7至28天之间显著升高（P = 0.008）。在控制了胎龄、产前和产后类固醇暴露因素后，出生后48小时维生素A水平低增加了发生慢性肺病的风险（每降低50μg/l的比值比：2.04，95%可信区间1.19 - 5.77）和支气管肺发育不良的风险（比值比1.96，95%可信区间1.14 - 6.87）。将我们的荟萃分析结果与其他已发表的前瞻性观察性研究结果相结合，发现患有慢性肺病的婴儿在所有时间点的血浆维生素A水平均较低。
我们的结果支持极低出生体重婴儿血浆维生素A水平低与不良预后之间存在关联。
