RESUMO
We conducted a randomized trial in very low birth weight neonates (n = 51) to determine whether vitamin A supplementation by enteral administration would increase plasma vitamin A concentrations to the same degree as by intramuscular administration. Mean plasma vitamin A concentrations were significantly higher in the intramuscular-administration group than in the enteral-administration group by postnatal day 7; this effect persisted throughout the remainder of the trial. At the dosage used in this trial, vitamin A supplementation by the enteral route is not as effective as that by the intramuscular route in very low birth weight neonates.
Assuntos
Recém-Nascido de Baixo Peso , Vitamina A/uso terapêutico , Nutrição Enteral , Feminino , Humanos , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido , Injeções Intramusculares , Intubação Gastrointestinal , Masculino , Nutrição Parenteral , Estudos Prospectivos , Vitamina A/administração & dosagem , Vitamina A/sangueRESUMO
We hypothesized that changes in plasma retinol-binding protein (RBP) concentration in response to vitamin A administration might be useful for evaluating vitamin A status of very low birth weight infants susceptible to bronchopulmonary dysplasia. We prospectively studied 24 consecutively admitted neonates (birth weight less than 1350 gm, gestational age less than 31 weeks, ventilator dependent for greater than 24 hours after birth), who were eligible to receive 2000 IU supplemental vitamin A by intramuscular injection on postnatal day 1 and on alternate days thereafter for 28 days. In addition to serial assessment of vitamin A status, we measured plasma RBP just before and 1, 3, and 6 hours after an intramuscular injection of vitamin A (2000 IU/kg retinyl palmitate) on days 1 and 28. The percent increase in plasma RBP (delta-RBP) was high (mean +/- SD: 61 +/- 37%) and plasma vitamin A and RBP values were low on day 1, indicative of vitamin A deficiency. Supplemental vitamin A improved vitamin A status of all infants as shown by low delta-RBP (mean +/- SD: 8 +/- 9%) and normal plasma vitamin A and RBP values on day 28. Bronchopulmonary dysplasia was diagnosed in 12 of 24 infants. Infants with bronchopulmonary dysplasia had a higher mean (+/- SD) delta-RBP on day 28 than those without bronchopulmonary dysplasia (13 +/- 10% vs 3 +/- 3%, p less than 0.01), indicative of persistence of low vitamin A status in infants with lung disease despite supplementation. We conclude that the plasma RBP response to vitamin A is a useful indicator of vitamin A status in very low birth weight infants. Although vitamin A supplementation at the dosage used in this study normalizes conventional plasma indexes of vitamin A in very low birth weight infants, the plasma RBP response to vitamin A may continue to reflect persistence of low vitamin A status in the more immature infants with significant lung disease. We suggest that the plasma RBP response to vitamin A may be a useful functional test in such infants.
Assuntos
Displasia Broncopulmonar/sangue , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido Prematuro/sangue , Proteínas de Ligação ao Retinol/análise , Vitamina A/farmacologia , Suscetibilidade a Doenças , Nutrição Enteral , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Injeções Intramusculares , Masculino , Prognóstico , Estudos Prospectivos , Proteínas Plasmáticas de Ligação ao Retinol , Fatores de Tempo , Vitamina A/administração & dosagem , Vitamina A/sangueRESUMO
We conducted a randomized, double-blind, controlled trial to determine whether vitamin A supplementation from early postnatal life could reduce the morbidity associated with bronchopulmonary dysplasia in very low birth weight (VLBW) neonates. Forty VLBW neonates (700 to 1300 g birth weight, 26 to 30 weeks gestational age), who were oxygen dependent and required mechanical ventilation for at least 72 hours after birth, were given by the intramuscular route either supplemental vitamin A (retinyl palmitate 2000 IU) or 0.9% saline solution on postnatal day 4 and every other day thereafter for a total of 14 injections over 28 days. The study groups were comparable in gestational maturity, clinical characteristics, initial lung disease, and vitamin A status at entry into the trial. Vitamin A administration resulted in significantly higher mean plasma concentrations of vitamin A and retinol-binding protein in treated infants compared with controls. Bronchopulmonary dysplasia was diagnosed in nine of 20 infants given vitamin A supplement and in 17 of 20 control infants (P less than 0.008). Four of 19 infants in the vitamin A group and 11 of 20 in the control group required mechanical ventilation on study day 28 (P less than 0.029). The need for supplemental oxygen, mechanical ventilation, and intensive care was reduced in infants given vitamin A supplement compared with controls. Airway infection and retinopathy of prematurity were less frequent in the vitamin A group. We conclude that vitamin A supplementation at the dosage used in this trial in VLBW neonates not only improves their vitamin A status but also appears to promote regenerative healing from lung injury, as evidenced by a decrease in the morbidity associated with bronchopulmonary dysplasia.
Assuntos
Displasia Broncopulmonar/prevenção & controle , Vitamina A/uso terapêutico , Displasia Broncopulmonar/sangue , Ensaios Clínicos como Assunto , Suscetibilidade a Doenças , Método Duplo-Cego , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Estudos Prospectivos , Distribuição Aleatória , Proteínas de Ligação ao Retinol/análise , Proteínas Plasmáticas de Ligação ao Retinol , Risco , Fatores de Tempo , Vitamina A/sangueAssuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Fezes , Humanos , Manejo de Espécimes , UrinaRESUMO
Sound levels were measured in a neonatal intensive care nursery as well as during transport in ambulance, rotary wing, and fixed wing aircrafts. In the nursery, under usual conditions, the sound levels were between 58 and 70 dB; while in transit, they were invariably higher, particularly in rotary wing aircarft ( greater than 90 dB). The observations suggest that neonates in transit are exposed to potentially hazardous sound levels. Provision of means to attenuate the sound is desirable as a part of stabilization of infant during transport.