Abstract
BackgroundVitamin A (VA) supplementation reduces the risk of developing bronchopulmonary dysplasia (BPD). However, a previous meta-analysis showed that VA had minimal efficacy for preventing BPD in very low birth weight infants (VLBWIs).AimsTo elucidate the effects of VA supplementation for BPD prevention in extremely low birth weight infants (ELBWIs).Study designThis systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered the protocol on PROSPERO, the international prospective registry of systematic reviews (registration number: CRD42016050887). We searched the following five databases: CINAHL, CENTRAL, EMBASE, MEDLINE, and PubMed; screened the reference lists of retrieved articles to identify randomized controlled trials (RCTs); and assessed the Cochrane Risk of Bias for each study. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.ResultsFour studies (total, 1,011 infants) were included. VA was administered intramuscularly in 3 studies and orally in 1 study. VA supplementation for ELBWIs had benefited oxygen dependency at the postmenstrual age of 36 weeks in survivors (pooled risk ratio, 0.88; 95% confidence intervals (CI), 0.77–0.99; 4 trials, 841 infants, moderate certainty of evidence), which is similar to the meta-analysis in VLBWIs. Length of hospital stay was reduced in the VA group (mean difference, −49.9; 95% CI, −88.78 to −11.02; 1 trial, 20 infants, low certainty of evidence). The meta-analysis showed no reduction in the risk of neonatal death, oxygen use at 28 days in survivors, duration of mechanical ventilation, intraventricular hemorrhage, retinopathy in prematurity, and necrotizing enterocolitis.ConclusionsVA supplementation for ELBWIs is potentially effective in decreasing oxygen dependency at the postmenstrual age of 36 weeks.
Highlights
Vitamin A plays an important role in the growth, differentiation, and maintenance of airway epithelial cells [1, 2] and has been an effective treatment intervention for premature infants suffering from the major respiratory sequel bronchopulmonary dysplasia (BPD)
Vitamin A (VA) supplementation for extremely low birth weight infants (ELBWI) had benefited oxygen dependency at the postmenstrual age of 36 weeks in survivors (pooled risk ratio, 0.88; 95% confidence intervals (CI), 0.77–0.99; 4 trials, 841 infants, moderate certainty of evidence), which is similar to the meta-analysis in very low birth weight infants (VLBWIs)
VA supplementation for ELBWIs is potentially effective in decreasing oxygen dependency at the postmenstrual age of 36 weeks
Summary
Vitamin A plays an important role in the growth, differentiation, and maintenance of airway epithelial cells [1, 2] and has been an effective treatment intervention for premature infants suffering from the major respiratory sequel bronchopulmonary dysplasia (BPD). In a clinical trial conducted in Europe, infants were supplemented with oral vitamin A to avoid repeated muscular injections; the trial is still in the process of recruiting patients [10, 12]. Another reason for the sparse use of Vitamin A might be that the largest study on extremely low birth weight infants (ELBWI;
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