VITAMIN-A-DEFICIENCY AND SEVERE BRONCHOPULMONARY DYSPLASIA IN VERY-LOW-BIRTH-WEIGHT INFANTS

Preterm infants often have abnormally tow serum vitamin A concentratio ns. Persistence of vitamin A deficiency for a prolonged postnatal peri od may contribute to the development of bronchopulmonary dysplasia. We retrospectively analyzed data from 22 infants with birthweight less t han or equal to 1250 g who had hyaline membrane disease requiring mech anical ventilation with oxygen and in whom serum vitamin A concentrati ons had been measured at the onset of enteral feeding and every 2 week s thereafter. Thirteen infants (low serum vitamin A group) had one or more serum vitamin A concentrations less than or equal to 11 mcg/dL at > 10 days of age. In 9 infants (higher serum vitamin A group) all ser um vitamin A concentrations were > 11 mcg/dL at > 10 days of age. Mean birthweight, mean gestational age, sex, race, incidence of antenatal maternal glucocorticoid treatment and ventilatory support on the first day of life were similar for the two groups. Severe bronchopulmonary dysplasia was defined as characteristic radiographic changes and eithe r discharge from the hospital with supplemental oxygen or death from r espiratory failure at > 28 days of age following mechanical Ventilatio n with oxygen since birth. The incidence of severe bronchopulmonary dy splasia was significantly higher in the low serum vitamin A group (11/ 13, 3 deaths vs. 1/9, no deaths; p=0.001). The incidence of pulmonary air leak, the number of ventilator days, the number of days of postnat al glucocorticoid treatment for chronic lung disease, the number of ep isodes of suspected sepsis and the number of days of antibiotic treatm ent also were higher in the low serum vitamin A group. Low serum vitam in A group infants were older at the onset of enteral feeding (21 days vs. 8 days; p=0.001) and during feeding their average daily enteral i ntake of vitamin A was lower (713 IU vs. 1255 IU; p=0.001) when compar ed with infants in the higher serum vitamin A group. Our retrospective analysis of data from these infants' confirms earlier reports from ot her workers that persistent marked vitamin A deficiency in very low bi rthweight infants is associated with a high incidence of severe bronch opulmonary dysplasia, delayed onset of enteral feeding and low enteral intake of vitamin A.