Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

The Effect of Oral Vitamin A in the Prevention of Retinopathy of Prematurity in Premature Infants with Low Birth Weight

Document Type : original article

Authors
Maryam Mohammadi 1
Maryam Shokouhi Solgi 2
Nasrin Jiriaee 3
Mohmammad Amin Rezaei 4
Behnaz Basiri 2
1 Behavioral disease research center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2 Neonatal Department, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
3 Department of Social Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
4 Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
10.22038/ijp.2024.82758.5484
Abstract
Background: Retinopathy of Prematurity (ROP) is one of the most common complications in premature babies, whose severe disease can have a long-term effect on the visual performance of babies. In some studies, it has been shown that the administration of vitamin A may be effective in these infants; however, sufficient studies have not been conducted in this field. This randomized clinical trial aimed at investigating the effect of oral vitamin A in the prevention of ROP among premature infants with low birth weight, admitted to the neonatal intensive care unit of Fatemiyeh Hospital.
Methods: In this clinical trial, 66 premature babies with a gestational age of less than 34 weeks who were admitted to the neonatal intensive care unit due to prematurity and respiratory distress were included. The patients were randomly divided into two groups and one group received 3000 units of oral vitamin A daily for 28 days or until discharge, in addition to the usual daily care. In the control group, only usual care was given. Stages of ROP were evaluated according to the International Classification of Retinopathy of Prematurity (ICROP). The rates of Necrotizing Entero-Colitis (NEC), Broncho-Pulmonary Dysplasia (BPD) and Intraventricular Hemorrhage (IVH) were investigated in both groups.
Results: Both groups had no statistically significant differences in terms of basic variables. No side effects were observed in the intervention group. The rates of Necrotizing Entero-Colitis (NEC), Broncho-Pulmonary Dysplasia (BPD) and Intraventricular Hemorrhage (IVH) were lower in the intervention group, but did not show a statistically significant difference with the control group. The incidence rate of ROP was found to be 43.4% in the intervention group and 59.4% in the control group (P=0.172). Among the 14 infants of the intervention group, where retinopathy of prematurity occurred, 7 patients had grades II and III, while 17 cases (89.5%) of the 19 affected infants had grades II and III in the control group (P=0.019).
Conclusion: Our findings revealed that the administration of oral vitamin A in premature infants with low weight can be an effective therapeutic strategy to reduce the risk of retinopathy.
Keywords
Prematurity
Retinopathy of prematurity
Vitamin A
  1. Fanaroff AA, Martin RJ. Neonatal-perinatal medicine: diseases of the fetus and infant.1987.
  2. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatrics in review. 2014 Oct 1;35(10):417-29.
  3. Sun H, Cheng R, Wang Z. Early vitamin A supplementation improves the outcome of retinopathy of prematurity in extremely preterm infants. Retina. 2020 Jun 1;40(6):1176-84.
  4. Garofoli F, Barillà D, Angelini M, Mazzucchelli I, De Silvestri A, Guagliano R, et al. Oral vitamin A supplementation for ROP prevention in VLBW preterm infants. Italian Journal of Pediatrics. 2020 Dec;46:1-4.
  5. Ugurbas SC, Gulcan H, Canan H, Ankarali H, Torer B, Akova YA. Comparison of UK and US screening criteria for detection of retinopathy of prematurity in a developing nation. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2010 Dec 1;14(6):506-10.
  6. Sabri K, Ells AL, Lee EY, Dutta S, Vinekar A. Retinopathy of prematurity: a global perspective and recent developments. Pediatrics. 2022 Aug 1;150(3).
  7. Kim SJ, Port AD, Swan R, Campbell JP, Chan RP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Survey of ophthalmology. 2018 Sep 1;63(5):618-37.
  8. Shah PK, Prabhu V, Karandikar SS, Ranjan R, Narendran V, Kalpana N. Retinopathy of prematurity: Past, present and future. World journal of clinical pediatrics. 2016 Feb 2;5(1):35.
  9. Shenai JP, Kennedy KA, Chytil F, Stahlman MT. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. The Journal of pediatrics. 1987 Aug 1;111(2):269-77.
  10. Landman J, Sive A, Heese HD, Van Der Elst C, Sacks R. Comparison of enteral and intramuscular vitamin A supplementation in preterm infants. Early human development. 1992 Sep 1;30(2):163-70.
  11. Ye Y, Yang X, Zhao J, He J, Xu X, Li J, et al. Early vitamin A supplementation for prevention of short-term morbidity and mortality in very-low-birth-weight infants: a systematic review and meta-analysis. Frontiers in Pediatrics. 2022 Apr 7;10:788409.
  12. Quinn GE, Dobson V, Davitt BV, Wallace DK, Hardy RJ, Tung B, et al. Progression of myopia and high myopia in the Early Treatment for Retinopathy of Prematurity study: findings at 4 to 6 years of age. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2013 Apr 1;17(2):124-8.
  13. González C R, Díaz C M, Garretón C R. Anti-vascular endothelial growth factor (VEGF) drugs compared to laser photocoagulation for treatment of type 1 retinopathy of prematurity. Medwave. 2022 Jan 17;22(01).
  14. Filippi L, Dal Monte M. A safety review of drugs used for the treatment of retinopathy of prematurity. Expert Opinion on Drug Safety. 2020 Nov 1;19(11):1409-18.
  15. B Beharry KD, Valencia GB, Lazzaro DR, Aranda JV. Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity. InSeminars in perinatology 2016 Apr 1 (Vol. 40, No. 3, pp. 189-202). WB Saunders.
  16. Onyango O, Sitati S, Amolo L, Murila F, Wariua S, Nyamu G, et al. Retinopathy of prematurity in Kenya: prevalence and risk factors in a hospital with advanced neonatal care. Pan African Medical Journal. 2018;29(1):1-7.
  17. Bahmani T, Karimi A, Rezaei N, Daliri S. Retinopathy prematurity: a systematic review and meta-analysis study based on neonatal and maternal risk factors. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):8032-50.
  18. Fang JL, Sorita A, Carey WA, Colby CE, Murad MH, Alahdab F. Interventions to prevent retinopathy of prematurity: a meta-analysis. Pediatrics. 2016 Apr 1;137(4).
  19. Mactier H, McCulloch DL, Hamilton R, Galloway P, Bradnam MS, Young D, et al. Vitamin A supplementation improves retinal function in infants at risk of retinopathy of prematurity. The Journal of pediatrics. 2012 Jun 1;160(6):954-9.
  20. Ozkan H, Duman NU, Kumral A, Kasap B, Ozer EA, Lebe B, et al. Inhibition of vascular endothelial growth factor-induced retinal neovascularization by retinoic acid in experimental retinopathy of prematurity. Physiological research. 2006 Jun 1;55(3).
  21. Wang L, Shi P, Xu Z, Li J, Xie Y, Mitton K, et al. Up-regulation of VEGF by retinoic acid during hyperoxia prevents retinal neovascularization and retinopathy. Investigative Ophthalmology & Visual Science. 2014 Jul 1;55(7):4276-87.
  22. Uberos J, Miras-Baldo M, Jerez-Calero A, Narbona-López E. Effectiveness of vitamin A in the prevention of complications of prematurity. Pediatrics & Neonatology. 2014 Oct 1;55(5):358-62.
  23. Darlow BA, Graham PJ, Rojas‐Reyes MX. Vitamin A supplementation to prevent mortality and short‐and long‐term morbidity in very low birth weight infants. Cochrane database of systematic reviews. 2016(8).
Journal of Pediatric Perspectives
Volume 12, Issue 7
July 2024
Pages 18902-18911