Vitamin A injections in VLBW preemies!!

  1. I took care of a 610 gm. preemie the other day who is being given IM injections of Vit. A 3x a week. I've never seen this before, it's a new tx for chronic lung disease...apparently it can't be given IV!!!
    This seems so harsh for such a little baby. The baby already has a huge bruise from the injection.
    Do the benefits of the drug outweigh the bruising and pain of the injection?

    I'm having a hard time with this. Don't most preemies this small get lung disease the majority of the time?

    Is Vit. A REALLY that effective?
    Has anyone here had to give a 610 gm. baby a SHOT?
    I've never had to, didn't have to on this baby either, but the leg loooked so bad and the docs verified no IV administration!

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  2. 17 Comments

  3. by   MA Nurse
    I'm surprised there aren't any responses about this yet. Is this a weird question? Or maybe nobody has experienced this before?
  4. by   ginger58
    Quote from Kimbalou
    I'm surprised there aren't any responses about this yet. Is this a weird question? Or maybe nobody has experienced this before?
    Haven't been in NICU since the mid 90s but did not experience vitamin A. I would think since it's a fat soluable vitamin one would need to be very careful with dosing and personally in any age person I find IM injections barbaric unless it can't be given any other route!

    I did a search under"premie+vitamin A" and it brought up some abstracts. Not sure it's been researched enough or made enough difference. Hate the thought of jabbing a 600 Gm premie.
  5. by   MA Nurse
    Quote from ginger58
    Haven't been in NICU since the mid 90s but did not experience vitamin A. I would think since it's a fat soluable vitamin one would need to be very careful with dosing and personally in any age person I find IM injections barbaric unless it can't be given any other route!

    I did a search under"premie+vitamin A" and it brought up some abstracts. Not sure it's been researched enough or made enough difference. Hate the thought of jabbing a 600 Gm premie.
    I found some studies online showing that Vit. A helps in preventing CLD, but it has to be given IM...but in such a tiny baby there isn't any "M", so I guess it's really kinda SQ!! OUCH!
  6. by   RainDreamer
    I've never heard of this, we haven't ever given Vitamin A, that I'm aware of.

    And yes, we do give micropremies like that shots .... but only Vitamin K, just one injection.
  7. by   KyElaine
    We've been giving Vit A injections on VLBW babies for quite some time now. We have a nutritionist that researched it and encouraged our physicians to use it. It is supposed to promote healthy lung tissue. We give it Mon-Wed-Fri. At first we all hated it and told the nutritionist that we were going to give HER the shots! Now, we've gotten used to it. Just make sure you have a small gague needle- like a 27 or 30. Go into the leg nice and easy and watch to see how deep you need to go in. You dont want to hit bone. (ugh!) I've seen people "dart" the needle in like you do on adults, and you just dont need to do it like that because their tissue is so much softer.
    I hope this helps!
  8. by   lovemyjob
    Quote from KyElaine
    We've been giving Vit A injections on VLBW babies for quite some time now. We have a nutritionist that researched it and encouraged our physicians to use it. It is supposed to promote healthy lung tissue. We give it Mon-Wed-Fri. At first we all hated it and told the nutritionist that we were going to give HER the shots! Now, we've gotten used to it. Just make sure you have a small gague needle- like a 27 or 30. Go into the leg nice and easy and watch to see how deep you need to go in. You dont want to hit bone. (ugh!) I've seen people "dart" the needle in like you do on adults, and you just dont need to do it like that because their tissue is so much softer.
    I hope this helps!
    Do your docs feel like it is making a difference? Are they seeing less BPD?
  9. by   LoveTheNICU
    We give 5000 units of Vitamin A to kids <1500 g on a M-W-F schedule for a total of 12 doses, and have been doing so for at least 15 months. It does seem awful and barbaric to stick the tiny 500-700g babies, but we use a 30g, 5/8in needle and dose them with sucrose first, and most do just fine. It DEFINITELY has made a difference in the respiratory status of our babies- today, in our 38 bed Level III, complete with ECMO capabilities and cardiac surgery and the whole shebang, we had NO oscillators or jets going, and only 3 kids on conventional vents. I took a 26 and 6/7 weeker off of CPAP and put him on a cannula, and he just satted to high heaven in 21% O2. We keep seeing results like this, and it's just lovely...
  10. by   MA Nurse
    Quote from LoveTheNICU
    We give 5000 units of Vitamin A to kids <1500 g on a M-W-F schedule for a total of 12 doses, and have been doing so for at least 15 months. It does seem awful and barbaric to stick the tiny 500-700g babies, but we use a 30g, 5/8in needle and dose them with sucrose first, and most do just fine. It DEFINITELY has made a difference in the respiratory status of our babies- today, in our 38 bed Level III, complete with ECMO capabilities and cardiac surgery and the whole shebang, we had NO oscillators or jets going, and only 3 kids on conventional vents. I took a 26 and 6/7 weeker off of CPAP and put him on a cannula, and he just satted to high heaven in 21% O2. We keep seeing results like this, and it's just lovely...
    Ok, thanks for the info. I do feel a little better about it all.
    Although, this 610 gm baby is already on an oscillator at DOL #3. But, the baby probably didn't receive enough shots to do any good yet. I think my hospital does the same dosing you mentioned.
  11. by   lovemyjob
    That sounds amazing!

    I have heard from some of the RT's that we have horrible BPD rates because we over oxygenate. Our docs have changed spo2 limits and hope that it will help us with weaning better. I wonder if this might be something we can try also...

    I found a great article on it....
    http://pediatrics.aappublications.or...ull/104/6/1369
  12. by   ginger58
    I took a 26 and 6/7 weeker off of CPAP and put him on a cannula, and he just satted to high heaven in 21% O2. Why was he on a cannula in room air?
  13. by   MA Nurse
    Quote from ginger58
    I took a 26 and 6/7 weeker off of CPAP and put him on a cannula, and he just satted to high heaven in 21% O2.

    Why was he on a cannula in room air?
    I've had babies on cannulas in room air before, sometimes they just need the liter flow for stimilation to help them breathe.
  14. by   Gompers
    Quote from Kimbalou
    I've had babies on cannulas in room air before, sometimes they just need the liter flow for stimilation to help them breathe.
    Yep, we'll do 1 or 2 LPM airflow and only blend in enough oxygen to help the baby saturate within the ordered range. If it's more than 2 LPM, we'll use the Fisher Paykel high flow humidified cannulas up to 6 LPM, also often on room air. With that, it's not just for stimulation, but it also creates almost like a CPAP effect - when you listen to their chests you can hear the airflow inflating their lungs so they don't have to breathe quite so hard.

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