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Effect of vitamin A supplementation on the urinary retinol excretion in very low birth weight infants

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Abstract

Despite high-dose vitamin A supplementation of very low birth weight infants (VLBW, <1500 g), their vitamin A status does not improve substantially. Unknown is the impact of urinary retinol excretion on the serum retinol concentration in these infants. Therefore, the effect of high-dose vitamin A supplementation on the urinary vitamin A excretion in VLBW infants was investigated. Sixty-three VLBW infants were treated with vitamin A (5000 IU intramuscular, 3 times/week for 4 weeks); 38 untreated infants were classified as control group. On days 3 and 28 of life, retinol, retinol-binding protein 4 (RBP4), glomerular filtration rate, proteinuria, and Tamm–Horsfall protein were quantified in urine. On day 3 of life, substantial retinol and RBP4 losses were found in both groups, which significantly decreased until day 28. Notwithstanding, the retinol excretion was higher (P < 0.01) under vitamin A supplementation as compared to infants of the control group. On day 28 of life, the urinary retinol concentrations were predictive for serum retinol concentrations in the vitamin A treated (P < 0.01), but not in the control group (P = 0.570).

Conclusion: High urinary retinol excretion may limit the vitamin A supplementation efficacy in VLBW infants. Advanced age and thus postnatal kidney maturation seems to be an important contributor in the prevention of urinary retinol losses.

What is Known:

• VLBW infants have low vitamin A status, even after 4-week high-dose vitamin A supplementation [Longardt AC, Eur J Clin Nutr 2014; Schmiedchen B, Longardt AC, Buehrer C, Raila J, Loui A, Schweigert FJ Neonatology 105:155-160, 2014]

• VLBW infants excrete high amounts of retinol [Nagl B, Loui A, Raila J, Felderhoff-Mueser U, Obladen M, Schweigert FJ Pediatr Nephrol 24:61-66, 2009]

What is New:

• Urine retinol excretion reduces with increasing age of VLBW infants and is not suitable to assess vitamin A status in VLBW infants

• High urinary retinol excretion may limit vitamin A supplementation efficacy in VLBW infants

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Abbreviations

ELISA:

Enzyme-linked immunosorbent assay

GFR:

Glomerular filtration rate

HPLC:

High performance liquid chromatography

i.m.:

Intramuscular

RBP4:

Retinol-binding protein 4

SGA:

Small for gestational age

THP:

Tamm–Horsfall protein

TTR:

Transthyretin

UPC:

Urine protein-to-creatinine ratio

VLBW:

Very low birth weight

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Acknowledgments

We are indebted to the infants and parents for taking part in this study and gratefully acknowledge the technical assistance. This work was supported by a grant from the Else Kröner-Fresenius-Stiftung; Subsidy Contract Number 2010_A151.

Authors’ contributions to manuscript

AL, ACL, JR, and FJS designed the research (project conception, development of overall research plan, and study oversight).

AL, ACL, and BS conducted the research (sample collection, data collection).

BS analyzed the data and performed statistical analysis.

BS wrote the paper.

AL, CB, and FJS had primary responsibility for final content.

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Authors and Affiliations

  1. Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany

    Bettina Schmiedchen, Jens Raila & Florian J. Schweigert

  2. Department of Neonatology, Charité University Medical Center, Berlin, Germany

    Ann Carolin Longardt, Andrea Loui & Christoph Bührer

Authors
  1. Bettina Schmiedchen
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  2. Ann Carolin Longardt
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  3. Andrea Loui
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  4. Christoph Bührer
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  5. Jens Raila
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  6. Florian J. Schweigert
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Corresponding author

Correspondence to Bettina Schmiedchen.

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Funding

This work was supported by a grant from the Else Kröner-Fresenius-Stiftung; Subsidy Contract Number 2010_A151.

Conflicts of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study protocol was approved by the Charité’s institutional review board (No. EA2/053/07) and written parental consent was obtained for each infant.

Informed consent

Written parental consent was obtained for each infant included into the study.

Additional information

Communicated by Patrick Van Reempts

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Schmiedchen, B., Longardt, A.C., Loui, A. et al. Effect of vitamin A supplementation on the urinary retinol excretion in very low birth weight infants. Eur J Pediatr 175, 365–372 (2016). https://doi.org/10.1007/s00431-015-2647-9

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  • DOI: https://doi.org/10.1007/s00431-015-2647-9

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