A new perspective on vitamin A for premature infants

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In a 1999 landmark trial, Tyson et al (N Engl J Med 1999;340:1962-8. https://doi.org/10.1056/NEJM199906243402505) reported that 4 weeks of intramuscular vitamin A reduced vitamin A deficiency and modestly reduced bronchopulmonary dysplasia (BPD) or death in preterm infants <1000 grams (relative risk, 0.89). However, in clinical practice, the use of vitamin A remains variable, in large part because of concerns about the pain of the injections along with the modest benefit. It is only natural to consider the selective use of vitamin A for infants at highest risk for poor outcomes, such as those infants who require higher levels of oxygen or mechanical ventilation support.