Elsevier

Early Human Development

Volume 56, Issue 1, September 1999, Pages 39-47
Early Human Development

Cord blood concentrations of vitamin A in preterm infants

https://doi.org/10.1016/S0378-3782(99)00032-8Get rights and content

Abstract

Plasma vitamin A concentrations were measured in cord blood samples from 56 infants of gestational ages <33 weeks. Outcome was followed prospectively. Mothers’ dietary habits and use of multivitamins during pregnancy were evaluated by means of a questionnaire. Vitamin A concentrations less than 1.05 μmol/l (low) were measured in 22, but levels below 0.7 μmol/l (deficient) only in two cases. The concentrations were not correlated with the infants’ gestational ages. Infants with low concentrations were significantly more often multiplets compared to those with normal levels and the vitamin A concentrations of the multiplets were significantly lower than those of the singletons. The outcome measures used and the mothers’ dietary habits and multivitamin use were similar in cases with low and normal vitamin A concentrations.

Multiple gestation seems to be correlated with low plasma vitamin A concentrations in preterm infants at birth, and a complete assessment of vitamin A status to detect possible deficiency might be indicated in these cases.

Introduction

Vitamin A (retinol) is essential for the maintenance of epithelial mucous-secreting and of the ciliated non-secretory cell integrity in the conducting airways, and vitamin A deficiency produces histopathological changes similar to bronchopulmonary dysplasia (BPD) in the tracheobronchial tree [1]. Prematurely born infants have been shown to have low vitamin A concentrations in plasma and umbilical cord blood [2], [3]. The role of vitamin A deficiency in the development of respiratory distress syndrome (RDS) and BPD is controversial.

Our aim was to investigate, whether vitamin A concentrations in cord blood correlate with outcome, especially with the development of RDS and BPD in preterm infants. We also sought to evaluate possible predictive factors, including maternal dietary habits, contributing to deficient concentrations of vitamin A at birth.

Section snippets

Patients

The study was approved by the Ethical Committee of Tampere University Hospital.

Fifty-six consecutive infants of gestational ages less than 33 weeks were enrolled provided an informed consent was obtained from their parents, and collection of a cord blood sample had succeeded. Data on perinatal problems, including diseases, pregnancy complications and administration of antenatal glucocorticoids were collected from the mothers’ patient records. Gestational ages were determined based on obstetric

Characteristics of infants with low and normal vitamin A concentrations

Vitamin A concentrations lower than 1.05 μmol/l were measured in umbilical blood samples from 22 infants and concentrations below 0.7 μmol/l in two cases. The clinical characteristics of the low- and normal vitamin A concentration groups are given in Table 1. There were no significant differences between the groups in gender, birth weight, gestational age and number of SGA infants. The correlation coefficient between gestational ages and vitamin A concentrations was 0.054, P=0.6959.

Almost half

Discussion

Plasma retinol concentrations may remain within normal limits in spite of decreased hepatic stores and the diagnosis of vitamin A deficiency cannot therefore be based on these concentrations alone. Circulating retinol concentrations might be indirectly depressed due to lowered levels of the vitamin A-carrying protein in cases with a high risk of protein/calorie malnutrition as in preterm infants [9]. Measurement of retinol-binding protein (RBP), the determination of the plasma retinol/RBP molar

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      From the plethora of published data, it can be concluded that a plasma retinol concentration of <0.35 μmol/l (10 mg/dl) in a preterm infant almost certainly indicates depletion of hepatic stores, and that plasma retinol concentrations ≥0.7 μmol/l (20 μg/dl) are probably indicative of vitamin A sufficiency,25,38 at least in those infants who have not received postnatal steroids. Placental cord and infant blood concentrations of vitamin A are increased by antenatal and postnatal steroids respectively9,15,39; in the rat model this increase in serum retinol is at the expense of pulmonary and hepatic stores and is only seen in vitamin A-sufficient subjects.40 Conversely, both hepatic and pulmonary stores of vitamin A were greater in those ELBW infants who had received postnatal steroids in addition to i.m. vitamin A, compared with vitamin A-supplemented infants who had not received postnatal steroids.15

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