Results
INDICATIONS
- vitamin A deficiency: To reduce the risk of chronic lung disease in high risk premature neonates with vitamin A deficiency. A moderate reduction in bronchopulmonary dysplasia at the postmenstrual age of 36 weeks was demonstrated in the vitamin A group compared with the control group in a meta-analysis (n=4 studies, 1,011 extremely low birth weight infants (birth weight of less than 1 kg)); risk reduction, 0.88 (95% CI, 0.77 to 0.99). There were no differences in neonatal death before 1 month, oxygen use at 28 days in survivors, duration of mechanical ventilation, frequency of any grade intraventricular hemorrhage, retinopathy of prematurity, or necrotizing enterocolitis in the vitamin A group compared with the control group. Dosages were 5,000 international units (water-soluble retinyl palmitate) IM 3 times weekly for 4 weeks, 5,000 international units/kg/day orally for 28 days, and 10,000 international units IM 3 times weekly starting at day 2 for a minimum of 2 weeks or until initiation of oral feeds. In the NICHD-sponsored trial, 14 infants needed to be treated to prevent 1 case of chronic lung disease. In a follow-up study of this trial, there were no significant differences in neurodevelopmental outcomes or mortality at 18 to 22 months corrected age between infants receiving vitamin A and controls; however, the original trial was not adequately powered to confirm these follow-up endpoints.
- Retinopathy of Prematurity (ROP): Vitamin A may reduce the incidence of ROP. More data are needed in severe ROP to determine the benefit of vitamin A
ADVERSE EFFECTS
See monitoring section. Concomitant vitamin A (particularly larger doses) and glucocorticoids (particularly dexamethasone) should be used cautiously as significant, short-term increases in plasma concentrations of retinol and retinol binding protein can occur. Preterm neonates from these studies were not receiving the high doses of vitamin A recommended while receiving dexamethasone therapy.
ADMINISTRATION
- Do not administer IV.
- Administer IM using a 29-g needle and insulin syringe.
MONITORING
Assess regularly for signs of toxicity: full fontanel, lethargy, irritability, hepatomegaly, edema, mucocutaneous lesions, and bony tenderness. Consider measuring plasma retinol concentrations if available, especially if patient is also receiving glucocorticoid therapy. Desired concentrations are approximately 30 to 60 mcg/dL. Concentrations less than 20 mcg/dL indicate deficiency, while those greater than 100 mcg/dL are potentially toxic