Vitamin A and Very Low Birthweight Babies (VitAL)
Information source: Glasgow Royal Infirmary
ClinicalTrials.gov processed this data on August 20, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Preterm Birth; Retinopathy of Prematurity
Intervention: Aquasol A (Drug); aquasol A (Drug); sham injection (Other)
Phase: Phase 4
Status: Completed
Sponsored by: Glasgow Royal Infirmary Official(s) and/or principal investigator(s): Helen Mactier, MD, Principal Investigator, Affiliation: Glasgow Royal Infirmary
Summary
Vitamin A is important for the development of healthy eyes and lungs. Very low birth weight
premature babies have low body stores of vitamin A and are prone to diseases of the eye and
lungs. Previous work has shown that intramuscular (IM) vitamin A reduces the number of
babies who require prolonged oxygen therapy, and may also reduce the number of babies
affected by retinopathy of prematurity (ROP)). There is also some evidence that the
conjunctiva shows signs of deficiency of vitamin A in premature infants, particularly those
who develop ROP. Our own work here in Glasgow suggests that, compared to babies born at
full term, premature babies' eyes are less sensitive to light and we believe that this may
reflect shortage of vitamin A in the eye. This study will examine the effects upon the eye
of giving extra intramuscular vitamin A to very low birth weight, premature infants. We
will also measure blood levels of vitamin A and calculate liver stores of this nutrient.
Clinical Details
Official title: Does Additional Vitamin A Supplementation Improve Retinal Function and Conjunctival Health in Very Low Birthweight Infants?
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Prevention
Primary outcome: retinal function at 36 corrected weeks
Secondary outcome: plasma levels of vitamin A at birth, 7 and 28 dayshepatic stores of vitamin A at 36 corrected weeks
Detailed description:
Eligible infant will be those infants born at < 32 completed weeks gestation and/or weighing
< 1501 grams birth weight who have been admitted to either Princess Royal Maternity or Queen
Mother's Hospital within the first 24 hours of life. If informed, written consent is
obtained within 48-72 hours of birth, the infant will be randomised into either control or
intervention group.
The intervention group will receive IM vitamin A (Aquasol A)10,000IU three times weekly;
control infants will receive mock injections. Injections will be continued for 4 weeks
(maximum 12 injections). If enteral feeds are tolerated (defined as more than 75% of
predicted intake via the enteral route)after the 14th day, oral vitamin A (as part of a
multivitamin preparation) will be commenced and IM vitamin A discontinued. The dose of oral
vitamin A will be 5000IU daily (= 0. 6ml Dalivit), continued through discharge from the
neonatal unit until the first birthday. The same oral vitamin supplement will be given to
all VLBW babies, whether or not enrolled in this study. For infants receiving parenteral
nutrition, Vitlipid N infant (4ml/kg/day) will be commenced on day 2, or at the discretion
of the attending neonatologist. This will be given in addition to IM vitamin A.
The study design is partially blinded whereby control infants will have mock injections (as
described by Tyson et al.), rather than placebo injections. Infants randomised to placebo
will simply have a sticking plaster applied to a leg prior to the screens being withdrawn.
The research nurse will therefore be blinded to the infant's randomisation.
Blood samples will be collected from enrolled infants at birth (or immediately after
randomisation), on day 7, day 28 and at 36 corrected weeks. Samples will be separated,
frozen and plasma retinol subsequently analysed by high pressure liquid chromatography.
The RDR test will be performed as close as practicable to 36 corrected weeks, and whenever
possible in conjunction with routine blood sampling. The baby will be given oral vitamin A,
2000IU/kg, and a second specimen of blood obtained 3 hours after administration of vitamin
A. As well as measurement of plasma retinol concentration, red blood cells will be analysed
for the DHA content of the cell membrane.
Retinal function will be assessed using the electroretinogram (ERG), in conjunction with
routine ROP screening and as close as possible to 36 corrected weeks. The ERG
luminance-response function will be recorded using different filters and background lighting
to distinguish rod and cone responses. Conjunctival impression cytology (CIC) will be
performed coincident with the ERG by taking a single sample from the bulbar conjunctiva,
using a Millicell® filter.
All infants will be examined weekly for signs of vitamin A toxicity, including mucocutaneous
lesions, bone and joint abnormalities and fullness of the anterior fontanelle. Weekly blood
tests during the period of IM injections will include full blood count and liver function.
Eligibility
Minimum age: N/A.
Maximum age: 72 Hours.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- Infants born at < 32 completed weeks gestation and/or weighing < 1501 grams birth
weight who have been admitted to either Princess Royal Maternity or Queen Mother's
Hospital within the first 24 hours of life.
Exclusion Criteria:
- Congenital ocular abnormality
Locations and Contacts
Princess Royal Maternity, Glasgow G31 2ER, United Kingdom
Queen Mother's Hospital, Glasgow G3 8SJ, United Kingdom
Additional Information
Starting date: January 2007
Last updated: June 24, 2010
|