Vitamin A to prevent bronchopulmonary dysplasia in very-low-birth-weight infants: has the dose been too low?

Abstract Objective : Inconsistent effects of vitamin A supplementation on prevention of bronchopulmonary dysplasia have been reported. Meta-analysis of these reports resulted in a relative risk of 0.69–1.02 for death or bronchopulmonary dysplasia associated with vitamin A supplementation. Effective dosage regimens or serum retinol concentrations have not been determined in previous reports. The purpose of this pilot study was to define a vitamin A regimen that produces serum retinol concentrations of 25–55 μg/dl. Study design : In this three-phase study, 91 infants (mean birth weight 799–864 g) were enrolled. Vitamin A was administered three times/week for 4 weeks at an average daily dose of 986–2143 IU/day. Physical examinations were performed and serum retinol specimens were collected weekly to assess clinical signs of toxicity. Results : The majority of serum retinol concentrations remained Conclusion : A large clinical trial of vitamin A supplementation with 5000 IU/dose three times/week (25–114% more than the dose used in the three published clinical trials) is needed to assess whether vitamin A supplementation safely reduces the risk of bronchopulmonary dysplasia in very-low-birth-weight infants.