Vitamin A supplementation for preventing morbidity and mortality in very-low-birth-weight infants
RHL practical aspects by Bhutta ZA
Based on the factors outlined above and the general necessity of providing care for VLBW infants in specialized centres, the practical implications of the findings of this Cochrane Review are only pertinent to referral hospitals.
FIRST CONTACT (PRIMARY CARE) LEVEL
The evidence reviewed indicates that it is important to ensure that mothers and newborns, especially if VLBW, receive adequate amounts of vitamin A (pro-vitamin A and carotenoids for women during pregnancy and exclusive breastfeeding). It may be more appropriate to consider a mix of strategies ranging from improved maternal nutrition and vitamin A supplementation in pregnancy, to targeted vitamin A supplementation in high-risk low-birth-weight infants.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Once high-risk VLBW infants are referred to tertiary centres to receive intensive care with the potential risk of complications, it may be prudent to ensure an adequate intake of vitamin A intake from the outset. Given the diverse range within studies, it is difficult to recommend a specific dose or mode of administration for vitamin A; it may be safe to ensure an intake of twice the recommended daily allowance of 583-1250 IU (1). This can be administered orally, and if regular breast milk intake can be assured, it would be acceptable to reduce the vitamin A intake to more physiological levels.
AT HOME OR IN THE COMMUNITY
- In Kleinman RE (Editor), Elk Grove Village, IL. Nutritional Needs of Preterm Infants. Pediatric nutrition handbook. American Academy of Pediatrics. Fourth edition:1998 p.56.
This document should be cited as: Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in very-low-birth-weight infants: RHL practical aspects (last revised: 26 March 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.