Vitamin A and Bronchopulmonary Dysplasia: Research, Issues, and Clinical Practice

Alpha-Tocopherol Concentration in Colostrum and Serum of Women With Premature Labor

OBJECTIVE

The aim of the study was to evaluate and compare the levels of alpha-tocopherol in colostrum milk and serum of mothers with premature birth, classified as severe prematurity and moderate prematurity.

METHODS

Cross-sectional study with 65 women, 18 births classified as severe prematurity (<32 weeks of gestation) and 47 as moderate prematurity (≥32 weeks of gestation). The study only included mothers without any conditions associated with pregnancy and who had a single conception without any malformation. Samples of serum and colostrum were collected during fasting in the immediate postpartum, and alpha-tocopherol was analyzed by high-performance liquid chromatography. To determine the biochemical nutritional status of vitamin E, a serum cutoff (11.6 μmol/L) was adopted. The Student t test for independent variables compared the average concentrations of alpha-tocopherol in serum and colostrum among prematurity groups. Differences were considered significant when P < 0.05.

RESULTS

The alpha-tocopherol concentrations in colostrum were similar in both groups, being 34.5 ± 20.2 μmol/L for women with severe prematurity and 35.1 ± 16.3 μmol/L for moderate prematurity. For the serum of puerperal women with severe prematurity, alpha-tocopherol concentration was, however, lower than in women with moderate prematurity, 22.2 ± 4.4 μmol/L versus 27.1 ± 8.6 μmol/L (P < 0.05). The serum levels of alpha-tocopherol indicated nutritional risk at 5.6% (n = 1) of women with severe prematurity and 4.3% (n = 2) for those with moderate prematurity.

CONCLUSIONS

Severe prematurity affected the levels of alpha-tocopherol in maternal serum; however, the level of prematurity did not change the concentration of vitamin E in colostrum.

VitaminA, E, and D deficiencies in tunisian very low birth weight neonates: prevalence and risk factors

BACKGROUND

Preterm neonates are at high risk of vitamin deficiencies, which may expose them to increased morbidity and mortality. This study aimed to determine the prevalence and risk factors for vitamin A, E, and D deficiencies in Tunisian very low birth weight (VLBW) neonates.

METHODS

A total of 607 VLBW and 300 term neonates were included in the study. Plasma vitamins A and E were assessed by high performance liquid chromatography and vitamin D was assessed by radioimmunoassay.

RESULTS

Prevalence of vitamin A, E, and D deficiencies were dramatically elevated in VLBW neonates and were significantly higher than term neonates (75.9% vs. 63.3%; 71.3% vs. 55.5%; and 65.2% vs. 40.4%, respectively). In VLBW neonates, the prevalence of vitamin deficiencies was significantly higher in lower classes of gestational age and birth weight. Vitamin E deficiency was associated with pre-eclampsia [odds ratio (OR) (95% confidence interval, 95% CI), 1.56 (1.01-2.44); p < 0.01] and gestational diabetes [4.01 (1.05-17.0); p < 0.01]. Vitamin D deficiency was associated with twin pregnancy [OR (95% CI), 2.66 (1.33-5.35); p < 0.01] and pre-eclampsia [2.89 (1.36-6.40); p < 0.01].

CONCLUSION

Vitamin A, E, and D deficiencies are very common in Tunisian VLBW neonates and are associated with pre-eclampsia. Improved nutritional and health support for pregnant women and high dose vitamins A, E, and D supplementation in VLBW neonates are strongly required in Tunisia.

KL4-surfactant (Lucinactant) protects human airway epithelium from hyperoxia

Exogenous surfactant is critical in the treatment of neonates with respiratory distress syndrome. Lucinactant (Surfaxin; Discovery Laboratories, Inc.) is a surfactant replacement therapy containing sinulpeptide, which may reduce lung inflammation. This study tested whether Lucinactant reduces markers of inflammation, damage and remodeling in human airway epithelial cells exposed to hyperoxia. Calu-3 monolayers cultured at an air-liquid interface were treated apically with 140 microL of normal saline, Lucinactant or Beractant (Survanta; Abbott Laboratories, Inc.). Treated monolayers were exposed to 60% O(2)/5% CO(2) for 24 or 72 h. Transepithelial resistance (TER; p < 0.001) and cell viability (p < 0.05) were greater in both surfactant groups compared with saline; by 72 h Lucinactant cells had greater TER than Beractant (p < 0.001). Surfactant treated groups secreted less IL-8 than saline (p < 0.001), whereas Lucinactant cells secreted less IL-6 than saline and Beractant (p < 0.001). Matrix metalloproteinase 7, expressed by saline and Beractant treated cells at 24 h, was attenuated by 72 h by Beractant (p < 0.001), but was never detected in Lucinactant cells. Histology indicated less injury with Lucinactant relative to Beractant and saline. These data suggest that Lucinactant was protective compared with Beractant and control.

Retinoids increase lung elastin expression but fail to alter morphology or angiogenesis genes in premature ventilated baboons

Retinoids regulate elastin synthesis by alveolar myofibroblasts and affect angiogenesis pathways, both of which are processes critical for alveolar development. Retinoids accelerate alveolarization in rodents and are now used therapeutically in premature infants at risk of bronchopulmonary dysplasia (BPD). This study examined the effects of retinoid supplementation on alveolar elastin expression and deposition and angiogenesis-related signaling in a primate model of BPD. Premature baboons delivered at 125 d of gestation after maternal steroid treatment were given surfactant and ventilated with minimal supplemental oxygen for 14 d with (n = 5) and without (n = 5) supplemental vitamin A (5000 U/kg/d) and compared with 140-d unventilated controls. Ventilatory efficiency index (VEI) and oxygenation index (OI) were not statistically different between ventilated treatment groups. Expression of vascular endothelial growth factor A (VEGF-A), fms-related tyrosine kinase 1 (Flt-1), and tyrosine kinase with immunoglobulin-like and EGF-like domains 1 (TIE-1) was repressed by premature delivery and mechanical ventilation and was not altered by retinoid supplementation. Retinoid supplementation did not enhance alveolar angiogenesis. Elastin expression was repressed by premature delivery and extended ventilation, and retinoid supplementation increased elastin expression specifically in alveolar myofibroblasts within alveolar walls. These results suggest that the small decrease in mortality among premature infants receiving retinoid supplementation may not be mediated through enhanced alveolar development.