Vitamin A and bronchopulmonary dysplasia: the next steps

Preterm infants are often vitamin A deficient, and vitamin A has functions that could mitigate the processes that lead to bronchopulmonary dysplasia. Therefore, supplementation of preterm infants with vitamin A to reduce the risk of bronchopulmonary dysplasia makes inherent sense. Testing the hypothesis, a landmark randomised controlled trial by Tyson and colleagues in 1999 that enrolled 807 extremely low birthweight (ELBW) infants showed that intramuscular vitamin A supplementation reduced biochemical evidence of vitamin A deficiency and decreased the risk of bronchopulmonary dysplasia. 1 Tyson JE Wright LL Oh W et al. Vitamin A supplementation for extremely-low-birth-weight infants. N Engl J Med. 1999; 340: 1962-1968 Crossref PubMed Scopus (469) Google Scholar However, the practice of vitamin A supplementation was not widely accepted because clinicians were not willing to administer regular intramuscular injections to achieve only a modest reduction in the incidence of bronchopulmonary dysplasia. The enteral supplementation route was studied in relatively small trials without conclusive evidence for the outcome of bronchopulmonary dysplasia. 2 Darlow BA Graham PJ Rojas-Reyes MX Vitamin A supplementation to prevent mortality and short- and long-term morbidity in very low birth weight infants. Cochrane Database Syst Rev. 2016; 2016CD000501 Google Scholar Early postnatal high-dose fat-soluble enteral vitamin A supplementation for moderate or severe bronchopulmonary dysplasia or death in extremely low birthweight infants (NeoVitaA): a multicentre, randomised, parallel-group, double-blind, placebo-controlled, investigator-initiated phase 3 trialEarly postnatal high-dose fat-soluble enteral vitamin A supplementation in ELBW infants was safe, but did not change the rate of moderate or severe bronchopulmonary dysplasia or death and did not substantially increase serum retinol concentrations. Full-Text PDF