Improved vitamin A supplementation regimen for breastfed very low birth weight infants

Objective: Preterm infants usually have low retinol status at birth and at discharge from hospital. We have evaluated a new protocol designed to improve plasma retinol in very low birth weight infants (VLBW, birth weight <= 1500 g). Design: An open intervention trial was conducted in which vitamin A was given in a human milk fortifier. The daily dose of vitamin A varied according to bodyweight and was given mixed with human milk instead of as a bolus. Blood samples were collected at inclusion and at discharge from hospital. Plasma was analyzed for retinol using high-performance liquid chromatography. The daily intake of vitamin A and plasma retinol concentration was compared with the vitamin protocol normally used in Norwegian hospitals. Results: Sixty VLBW infants were included and 53 completed the study. At discharge from hospital, the reference group had lower median plasma retinol concentrations compared to the modified group (0.30 mu M vs. 0.49 mu M, p = 0.008). Fewer infants in the modified group had plasma retinol levels below 0.35 mu M (indicating reduced hepatic stores) compared to infants in the reference group (44% vs. 69%, p = 0.04). Conclusion: The modified protocol improved plasma retinol levels at discharge compared to the reference protocol.