Vitamin A Supplementation For Prevention Of Bronchopulmonary Dysplasia: A Meta-analysis

Objective:To systematically assess the efficacy and safety of early postnatal supplementation of vitamin A in preterm infants in the prevention of bronchopulmonary dysplasia.Methods:Databases includ-ing PubMed,EMBASE,The Cochrane Library,CBM,WanFang Data,CNKI and VIP were searched to collect randomized controlled trials(RCTs)about early postnatal supplementation of vitamin A in preterm in-fants in the prevention of bronchopulmonary dysplasia from inception to March 1,2018.Two reviewers independently screened literatures ac-cording to the inclusion and exclusion criteria,assessed the methodologi-cal quality of included RCTs,and extracted data.In the event of disa-greements,we sought the opinion of a third party.Then meta-analysis was conducted by RevMan 5.3 software.Subgroup analysis was per-formed according to different routes of administration,dichotomous var-iable used relative risk as effect index,continuous variable used mean difference as effect index,each effect size was expressed with 95%confi-dence interval,heterogeneity among studies was analyzed by chi-square test,when I~2 was less than or equal 50%,its heterogeneity was acceptable.Results:A total of 9 RCTs,involving 1 409 neonates were included.The results showed that,compared with the control group,supplementation of vitamin A group’s incidence of oxygen inhalation at 36 weeks’postmen-strual age was lower(RR=0.86,95%CI 0.75 to 0.98,P=0.02)with statis-tical difference.In the treatment group,the incidence of oxygen inhalation at 28 days,mortality at 36 weeks’postmenstrual age,mortality at 28days,retinopathy of prematurity(ROP),intraventricular haemorrhage(IVH),IVH stageⅢorⅣ,necrotising enterocolitis(NEC),sepsis,patent ductus arteriosus(PDA)were lower,the difference was not statistical significant.Treatment group’s incidence of mortality before discharge,retinopathy of prematurity requiring laser therapy were higher without statistical differ-ence.When supplementation of vitamin A by intramuscular injection,the incidence of oxygen inhalation at 36 weeks’postmenstrual age(RR=0.85,95%CI 0.73 to 0.98,P=0.03),ROP(RR=0.61,95%CI 0.38 to 0.98,P=0.04)were lower,and days on oxygen therapy(MD=-28.03,95%CI-31.20 to-24.87,P<0.00001)were shorter,the difference was statistical difference.Supplementation of vitamin A intramuscularly,the incidence of oxygen inhalation at 28 days,mortality at 28days,IVH,IVH stageⅢorⅣ,NEC,NEC stageⅢ,sepsis,PDA,increase in fontanelle tension,vomiting,seizures were lower without statistical difference and the inci-dence of mortality at 36 weeks’postmenstrual age,mortality before dis-charge,ROP requiring laser therapy were higher without statistical dif-ference.When supplementation of vitamin A orally,the incidence of ox-ygen inhalation at 36 weeks’postmenstrual age,mortality at 36 weeks’postmenstrual age,mortality at 28 days,IVH stageⅢorⅣwere lower without statistical difference and the incidence of oxygen inhalation at 28days,ROP,NEC stageⅢ,sepsis,PDA were higher without statistical difference,no statistical significant difference between the two groups were shown on the incidence of ROP requiring laser therapy,sepsis.Given by intravenous injection,the incidence of oxygen inhalation at 28days was lower,the difference was not statistical significant.Conclusions:Supplementation of vitamin A by intramuscular injection decrease the in-cidence of oxygen inhalation at 36 weeks’postmenstrual age,and there is no significant difference on the incidence of oxygen inhalation at 28 days.When given orally,there is no significant difference on the incidence of oxygen inhalation at 36 weeks’postmenstrual age or 28 days.Supplementation of vitamin A by intravenous injection has no significant difference on the incidence of oxygen inhalation at 28 days.It is safe when vitamin A is supplementated by routine does.More high quality studies are needed to verify the above conclusion because of the limited quality and quantity of included studies.