Neonatal Intensive Care Drug Manual

-Added to an enteral or bottle feed

-Put a drop on your gloved finger and then into baby’s mouth

-As a drop directly onto baby’s tongue or into mouth

- Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementation and are usually given vitamin A supplements once enteral feeding has been established. ^{1, 3}

- Vitamin A supplementation may be required in infants and children with liver disease, particularly cholestatic liver disease, or short Bowel syndrome due to the malabsorption of fat soluble vitamins. Treatment is sometimes initiated with very high doses of vitamin A and the infant should be monitored closely; very high doses are associated with acute toxicity.¹

- Vitamin supplementation should continue at least three months after resolution of jaundice as there is a delay before normal bile flow is established. ²

- Vitamin A may have benefits for preterm infants in the prevention of chronic lung disease. A meta-analysis of relatively high-dose vitamin A supplementations in infants <1500 g concluded that the incidence of oxygen requirement by 36 weeks corrected age was reduced.⁴ i

Bio-Logical Vitamin A and E Solution- 1mL contains 2210 IU (663 microg) Vitamin A and 102 IU Vitamin E

Penta-vite oral solution. Each 0.45mL contains 1470 IU (490 micog) Vitamin A and other vitamins (refer to Penta-Vite drug page)

Retinol – RBP <0.8 mol/mol defines deficiency when retinol < 0.7 umol/L

If treating deficiency, recheck levels in 2-4 weeks post treatment

1. 
   1. Vitamin A drops. https://www.starship.org.nz/guidelines/vitamin-a-retinol-vitamin-a-drops/ Accessed 1-3-2021
   
2. 
   2. Dani C, Pratesi S, Raimondi F, Romagnoli C; Task Force for Hyperbilirubinemia of the Italian Society of Neonatology. Italian guidelines for the management and treatment of neonatal cholestasis. Ital J Pediatr. 2015;41:69. Published 2015 Oct 1. doi:10.1186/s13052-015-0178-7
   
3. 
   3. Darlow BA, Graham PJ, Rojas-Reyes MX. Vitamin A supplementation to prevent mortality and short- and long-term morbidity in very low birth weight infants. Cochrane Database of Syst Rev. 2016;8:CD000501
   
4. 
   4. Araki S, Kato S, Namba F, Ota E. Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis. PLoS One. 2018 Nov 29;13(11):e0207730. doi: 10.1371/journal.pone.0207730. PMID: 30496228; PMCID: PMC6264498.