Clinical efficacy of different supplemental doses of vitamins A and D in preventing bronchopulmonary dysplasia in preterm infants: A network meta-analysis based on randomized controlled trials

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a prevalent and severe chronic respiratory condition in preterm infants, with vitamin deficiency recognized as a contributing factor. Although vitamins A and D are known to play protective roles in lung development, the optimal supplementation doses for BPD prevention remain unclear. METHODS: Search PubMed, Ovid, the Cochrane Library, Web of Science, CNKI, and Wanfang from database inception to November 30, 2024, identifying randomized controlled trials that investigated the role of vitamins A and D in the prevention of BPD in preterm infants. Data were extracted for network meta-analysis. Patient demographic data, the incidence of BPD, mortality, and mechanical ventilation duration were analyzed. RESULTS: In our analysis, encompassing 20 studies with 4357 patients, we observed that high-dose vitamin D (HDVD, ≥800 IU/d) demonstrated the most notable reduction in the incidence of BPD; low-dose vitamin A (LDVA, <3330 IU/d) exhibited the lowest mortality; high-dose vitamin A (≥3330 IU/d) had the shortest mechanical ventilation duration. CONCLUSION: Current scholarly literature suggests that HDVD (≥800 IU/d) supplementation may be the most effective regimen for preventing BPD in preterm infants, followed by LDVA (<3330 IU/d). No statistically significant differences in mortality were observed among any of the supplementation strategies or placebo. High-dose vitamin A (≥3330 IU/d) was associated with a shorter duration of mechanical ventilation. Consequently, to prevent BPD in preterm infants, supplementation with HDVD (≥800 IU/d) and LDVA (<3330 IU/d) may be considered.