Vitamin A for Extremely Low Birth Weight Infants, 7/1999 

Infants born with extremely low birth weights (less than 2 lbs.) are at risk of chronic lung disease, infection and death. A significant proportion of these disorders and deaths have been associated with a Vitamin A deficiency; however, "associated with" does not necessarily mean "due to". Extremely low birth weight infants generally have a low store of Vitamin A at birth; also after birth, they have low amounts of Vitamin A in their feedings and a poor absorption of Vitamin A from their digestive tract. 

Would supplemental administration of Vitamin A to extremely low birth weight infants needing respiratory assistance increase their rate of survival without chronic lung disease and reduce the risk of sepsis (infection)? Also, would there be any undesirable side effects of the Vitamin A administration? 

The results of a carefully designed clinical trial of the intramuscular injection of 5000 IU of Vitamin A three times a week for four weeks was recently published.¹ The study results indicated a reduction in the biochemical (blood) evidence of Vitamin A deficiency and a 6% reduction in the occurrence of chronic lung disease. There was no protection against death and only a marginal beneficial effect in protecting against sepsis. There was no evidence of complications due to Vitamin A injection. 

Comment: 

The extremely low-birth weight infant has a multitude of problems in staying alive and also in surviving without serious damage. Two organs at great risk of damage are the lungs and the brain. Chronic lung disease is a major problem in surviving infants who often require respiratory assist devices for periods after birth. A low blood level of Vitamin A is often found in these infants and is believed to be a factor in poor lung development. However, there has been concern about using injections of Vitamin A because of the potential undesirable effects of too much of the Vitamin being given by injection (Vitamin A is a fat soluble vitamin and poorly excreted in the urine. Thus, Vitamin A toxicity due to too much Vitamin A could be an important problem if injected rather than taken orally.)  

This trial evaluated both issues: benefits and toxicity. It showed that there was some benefit to lung development of Vitamin A injections and the dosage schedule that was used had no injurious side effects. Although a 6 % improvement in outcome is desirable, it is disappointing that there wasn't an even better positive result. On the other hand, it did help some infants and will now be considered for the care of the extremely low birth weight infant.  

The proper care of the very low birth weight infant is still a major medical problem. Neonatal care has come a long way in the past 10 years but even modern incubators and nutritional and drug administration are still no real substitute for the uterus. The necessary nutritional, hormonal and other materials supplied by means of the placenta are still only marginally understood for administration by available feedings and injections. A larger and larger proportion of very low birth weight infants are now able to survive, but their organs (e.g. lung; brain) are at great risk of under-development and injury. Remember, low birth weight continues to be among the most important risk factors for cerebral palsy. It is estimated that about 1/3 of very low birth weight infants are brain damaged.  

Research to provide better care for the low birth weight infant is very important and needs to be encouraged vigorously and supported; however, the most important breakthrough will occur when we are able to prevent premature birth of low birth weight babies--one of the major goals of the UCP Foundation research program.  

¹ Tyson JE et al. Vitamin A Supplementation for Extremely Low-Birth-Weight Infants. NEJM 1999 340:1962-68  

© UCP Research & Educational Foundation, July 1999

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