A Trial of vitamin A therapy to facilitate ductal closure in premature infants

• Published in: The Journal of pediatrics 2003-11, Vol.143 (5), p.644-648
• Main Authors: Ravishankar, Chitra, Nafday, Suhas, Green, Robert S, Kamenir, Steven, Lorber, Richard, Stacewicz-Sapuntzakis, Maria, Bridges, Nancy D, Holzman, Ian R, Gelb, Bruce D
• Format: Article
• Language: English
• Subjects: Birth Weight; Double-Blind Method; Ductus Arteriosus, Patent - diagnosis; Ductus Arteriosus, Patent - drug therapy; Electrocardiography; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Prospective Studies; Severity of Illness Index; Vitamin A - therapeutic use
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/S0022-3476(03)00501-8

To determine whether postnatal vitamin A therapy increased ductal closure rate in premature infants. This was a prospective, double-blind, placebo-controlled trial. Subjects (n=40) were recruited on day of life 1. Inclusion criteria were premature neonates weighing 500 to 1500 g with an indwelling umbilical line. Vitamin A was administered intramuscularly on days 1, 3, and 7. Blood vitamin A and retinol binding protein levels were obtained on days 1 and 3. Echocardiography was performed on days 1, 3, 7, and 14. Failure of ductal closure was defined as the presence of a moderate to large patent ductus arteriosus on day 14, indomethacin therapy, or surgical ligation. Comparison between the treatment and placebo groups revealed no differences in gestational age, weight, or oxygenation index. Vitamin A and retinol binding protein levels did not differ between the groups at entry but increased significantly after vitamin A treatment. Failure of ductal closure occurred in 22 of 40 babies without any difference between the groups (12/22 vs 10/18, P=NS). Four infants required surgical ligation, all in the treatment group (P=.04). Clinical outcome did not vary between groups. Postnatal vitamin A therapy did not improve ductal closure rates in premature infants.