Preterm infants often have abnormally low serum
vitamin A concentrations. Persistence of
vitamin A deficiency for a prolonged postnatal period may contribute to the development of
bronchopulmonary dysplasia. We retrospectively analyzed data from 22 infants with
birthweight < or = 1250 g who had
hyaline membrane disease requiring
mechanical ventilation with
oxygen and in whom serum
vitamin A concentrations had been measured at the onset of
enteral feeding and every 2 weeks thereafter. Thirteen infants (low serum
vitamin A group) had one or more serum
vitamin A concentrations < or = 11 mcg/dL
at > 10 days of age. In 9 infants (higher serum
vitamin A group) all serum
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 as defined as characteristic radiographic changes and either discharge from the hospital with supplemental
oxygen or death from
respiratory failure at > 28 days of age following
mechanical ventilation with
oxygen since birth. The incidence of severe
bronchopulmonary dysplasia 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 postnatal
glucocorticoid treatment for chronic
lung disease, the number of episodes of suspected
sepsis and the number of days of
antibiotic treatment also were higher in the low serum
vitamin A group. Low serum
vitamin 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 intake of
vitamin A was lower (713 IU vs. 1255 IU; p = 0.001) when compared with infants in the higher serum
vitamin A group. Our retrospective analysis of data from these infants confirms earlier reports from other workers that persistent marked
vitamin A deficiency in very low
birthweight infants is associated with a high incidence of severe
bronchopulmonary dysplasia, delayed onset of
enteral feeding and low enteral intake of
vitamin A.