{
  "abstract": "Vitamin A is an essential fat-soluble vitamin required for vision, bone growth, immune function, and differentiation of epithelial and nerve tissues. 1 Both deficiency and toxicity are associated with significant morbidity in children, such as vision loss and increased intracranial pressure or headaches. Vitamin A has a long half-life; levels can remain elevated for extended periods.2 Regular monitoring is recommended for children receiving long-term parenteral nutrition (PN).3The aim of the study was to review the frequency and duration of high serum vitamin A levels in children receiving home PN, and explore any associations between elevated levels with lipid provision or supplemental feeds.A retrospective review was conducted of all children currently receiving home PN under the care of the intestinal failure multidisciplinary team. Data were collected on demographic characteristics, underlying pathology leading to IF, time on PN, vitamin A levels, lipid and vitilipid doses, and any clinical symptoms suggestive of hypervitaminosis A. Episodes of high vitamin A were defined as levels above the laboratory reference range for at least three consecutive months over the last two years, while the child had a normal CRP.Thirty-nine children were on home PN (20 male, mean age 9 years, range 1–18 years). The main underlying conditions included short bowel syndrome (27/39, 69.2%), congenital diarrhoea (7/39, 17.9%), dysmotility (3/39, 7.7%), and other pathologies such as cystinosis (1/39, 2.6%) and eosinophilic colitis (1/39, 2.6%).Twenty-three of 39 (59%) children had elevated vitamin A lasting three months or more. Of these, 19/39 (48.7%) had one episode lasting at least three months and 4/39 (10.3%) had two prolonged episodes. None had more than two episodes. Four of 39 (10.3%) patients had prolonged elevation for the entire 24-month study despite reduced vitilipid dose (2/4 children (50%) had cholestasis). The median initial vitamin A concentration across all episodes was 2.05 (95% SD 3.32).Of all 27 episodes of raised vitamin A, 6/27 (22.2%) normalised after one reduction of vitilipid by 10%–25%. A further 4/27 (14.8%) resolved after multiple reductions in vitilipid content, ranging from a total reduction of 40%–55%. The remaining 13/27 (48.1%) episodes remained unresolved with levels above the reference range in September 2025, despite reductions in vitilipid on one (8/13) or more (5/13) occasions, ranging from 15% to 79% total reduction.Only one episode was associated with clinical symptoms compatible with hypervitaminosis A, including headache and irritability. Comparison between patients requiring a 10%–40% reduction of vitilipid (n=13) and those requiring >40% (n=8) did not differ in lipid nights per week (4.9 vs 4.6 nights, p=0.35) or the number on supplemental feeds (8/13 vs 3/8 respectively).Conclusion Episodes of high vitamin A levels are common in children on home PN and may persist for several months. Although vitilipid provision should be amended, other factors—including interindividual variation in metabolism—may affect vitamin A levels. Any reduction in vitilipid should be made cautiously to avoid secondary deficiencies of other fat-soluble vitamins.References Ross AC. Vitamin A. In: Ross AC, Caballero B, Cousins RJ, et al. editors. Modern Nutrition in Health and Disease. 11th ed. Baltimore (MD): Lippincott Williams & Wilkins; 2014. p. 260–277.Haskell MJ, Lembcke JL, Salazar M, et al. Population-based plasma kinetics of an oral dose of [2H4]retinyl acetate among preschool-aged Peruvian children. Am J Clin Nutr. 2003 Mar;77(3):681–686.Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr. 2022 Jun;41(6):1357–1424.",
  "authors": [
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Abigail Barnes"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Rachel Wood"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Zain Butt"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Timothy James Morris"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    }
  ],
  "title": "OC51 Incidence and persistence of elevated vitamin A levels in paediatric patients on home parenteral nutrition",
  "uid": "f6e86c68-188c-5bf7-a5f6-433e8169990f"
}