Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis

• Published in: PloS one 2018-11, Vol.13 (11), p.e0207730-e0207730
• Main Authors: Araki, Shunsuke, Kato, Shin, Namba, Fumihiko, Ota, Erika
• Format: Article
• Language: English
• Subjects: Age; Biology and Life Sciences; Birth weight; Bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - prevention & control; Care and treatment; Cell differentiation; Childbirth & labor; Chronic illnesses; Clinical trials; Confidence intervals; Dependence; Disease; Disease prevention; Dysplasia; Enterocolitis; Evaluation; Guidelines; Health aspects; Hemorrhage; Hospitals; Humans; Infant mortality; Infant, Extremely Low Birth Weight; Infants; Intervention; Intraventricular hemorrhage; Literature reviews; Low birth weight; Lung diseases; Mechanical ventilation; Medicine and Health Sciences; Meta-analysis; Methods; Necrotizing enterocolitis; Neonates; Newborn infants; Oxygen; Pediatrics; Physical sciences; Premature infants; Prevention; Quality; Research and Analysis Methods; Retinopathy; Reviews; Risk assessment; Supplements; Systematic review; Ventilation; Veterans hospitals; Vitamin A; Vitamin A - pharmacology; Vitamins; Weight
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0207730

Vitamin A (VA) supplementation reduces the risk of developing bronchopulmonary dysplasia (BPD). However, a previous meta-analysis showed that VA had minimal efficacy for preventing BPD in very low birth weight infants (VLBWIs). To elucidate the effects of VA supplementation for BPD prevention in extremely low birth weight infants (ELBWIs). This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered the protocol on PROSPERO, the international prospective registry of systematic reviews (registration number: CRD42016050887). We searched the following five databases: CINAHL, CENTRAL, EMBASE, MEDLINE, and PubMed; screened the reference lists of retrieved articles to identify randomized controlled trials (RCTs); and assessed the Cochrane Risk of Bias for each study. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Four studies (total, 1,011 infants) were included. VA was administered intramuscularly in 3 studies and orally in 1 study. VA supplementation for ELBWIs had benefited oxygen dependency at the postmenstrual age of 36 weeks in survivors (pooled risk ratio, 0.88; 95% confidence intervals (CI), 0.77-0.99; 4 trials, 841 infants, moderate certainty of evidence), which is similar to the meta-analysis in VLBWIs. Length of hospital stay was reduced in the VA group (mean difference, -49.9; 95% CI, -88.78 to -11.02; 1 trial, 20 infants, low certainty of evidence). The meta-analysis showed no reduction in the risk of neonatal death, oxygen use at 28 days in survivors, duration of mechanical ventilation, intraventricular hemorrhage, retinopathy in prematurity, and necrotizing enterocolitis. VA supplementation for ELBWIs is potentially effective in decreasing oxygen dependency at the postmenstrual age of 36 weeks.