Vitamin A supplement reduces bronchopulmonary dysplasia risk in very-preterm infants

Supplementation with vitamin A reduces the risk of bronchopulmonary dysplasia (BPD) in very-low-birthweight (VLBW) infants, but the benefit appears to be limited to those with baseline intake <1,500 IU · kg⁻¹ · d⁻¹ and is not affected by the administration route, a study has found.

A team of investigators conducted a systematic review using the Cochrane systematic review methodology and included randomized controlled trials that examined vitamin A supplementation for reducing morbidity and mortality in very-preterm or VLBW infants.

The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) recommendations were used to assess the certainty of evidence. Finally, prespecified subgroup analyses were carried out to evaluate factors that might alter the effects of vitamin A supplementation.

Seventeen studies (n=2,471) were included in the qualitative synthesis and 15 (n=2,248) in the quantitative synthesis. Moderate-certainty evidence suggested a beneficial effect of vitamin A for lowering the risk of BPD at 36 weeks postmenstrual age (relative risk, 0.83, 95 percent confidence interval [CI], 0.74‒0.93; numbers needed to treat for an additional beneficial outcome, 16, 95 percent CI, 9‒53; nine studies; n=1,752; p=0.002).

In subgroup analysis, the beneficial effect of vitamin A supplementation was observed only in infants with baseline intake <1,500 IU · kg⁻¹ · d⁻¹. Both enteral and parenteral routes were effective.

Of note, vitamin A supplementation had no adverse effects and did not affect mortality prior to discharge (12 studies; n=1,917) or neurodevelopmental outcomes at 18–22 months (1 study; n=538).