Dose: 1400 IU (420 mcg retinol) PO (see comments)
Vitamin A
| Dose: 1400 IU (420 mcg retinol) PO (see comments) |
| Frequency: Q Day |
| Indications: Current recommendations are that neonates and infants less than 6 months receive around 420 mcg of retinol per day (1400 IU). This is approximate what a term infant who is breast fed would receive if the infant consumed 750 cc of breast milk per day. Infants receiving routine formula would receive about 1900 IU using the above scenario. Preterm infants may not receive an adequate intake using formula alone. For infants < 32 weeks gestation, some would recommend that they at least receive 1000 IU or 330 mcg of vitamin A per day during the first month of life. However there is no data to determine whether vitamin A requirements should be based on gestational age or weight during the first 6 months of life [Zachman, "Vitamin A," Nutrition during infancy, Tsang and Nichols (ed.), page 261, 1988.] Sources of vitamin A available to infants include: |
Source |
Amount of vitamin A available |
| Multivitamins | 1500 IU/ml |
| Human Milk | 1670 IU/liter |
| Similac 20 cal/oz | 2500 IU/liter |
| SC-20 | 4580 IU/liter |
| SC-24 | 5500 IU/liter |
| Isomil | 2500 IU/liter |
| Pregestimil | 2000 IU/liter |
| Portagen | 5200 IU/liter |
| MVI (< 1000 grams) | 2300 IU/5 ml |
| MVI (1000 to 3000 grams) | 1495/3.25 ml |
| MVI (> 3000 grams) | 690 IU/1.5 ml |
IV administration of vitamin A is unreliable. This is due to absorption of the vitamin by the plastic tubing and photodegradation of the vitamin by light. Between 50% and 75% of the vitamin A is estimated to be lost before the IV fluid reaches the infant. This can be reduced by covering the IV bag with light-resistant vinyl covering. However, no cases of recognized symptomatic vitamin A deficiency or toxicity have been documented in infants receiving the currently recommended doses of MVI with their TPN (Etches, J Perinatol, 8:93, 1988). Use of supplemental vitamin A has been recommended for VLBW infants to decrease the incidence of chronic lung disease. The literature is summarized at vitamin A commentary. Further comments on vitamin A.
| Toxicity: Acute toxicity has occurred with single doses of 100,000 IU. This is manifested by a bulging cranial fontanel, nausea, vomiting, fever, and neurological symptoms (irritability, drowsiness, and seizures). With chronic toxicity, symptoms have included dry skin, alopecia, and headaches. Continued overuse can lead to hepatotoxicity, bone fractures, and death (polar bear liver story) [Zachman, "Vitamin A," Nutrition during infancy, Tsang and Nichols (ed.), page 261, 1988.] |
| Preparation: Vitamin A (Aquasol A) is available
in 30 cc bottle (5000 IU/0.1 ml or 5000 IU/3 qtts). Store at room temperature and protect
from light. |
| Compatibility: Compatible with TPN and
intravenous fat emulsions. |