Bronchopulmonary dysplasia (BPD) continues to be one of the most important challenges in the　care　of the preterm infants, affecting approximately one-quarter of very low birth weight infants [1]. With better availability and improved quality of care of neonatal intensive care units (NICUs) in India, more and more such babies are surviving. As vitamin A is accumulated mainly in the third trimester, preterm infants may have low vitamin A levels at birth, which may contribute to an increased　risk　of developing　BPD. With the large number of preterm babies surviving, there is possibility of an increase in number of BPD cases.

Most of randomized trials to study efficacy of vitamin A supplementation to prevent BPD used parenteral preparations. Globally, trials testing efficacy of oral vitamin A supplementation in preventing BPD has not shown its role [2].

During the last few years there is increasing difficulty in getting intramuscular preparations of vitamin A. Thus currently virtually no vitamin A injections are available in Indian market, making it one of latest addition in orphan drugs. India still lacks appropriate policy framework for orphan drugs, making a country-specific Orphan Drugs Act (ODA), need of the hour [2]. Well-designed multicenter trials should be done in Indian setting to study role of oral vitamin A in preventing BPD. Until efficacy of oral vitamin A is proved, Indian Academy of Pediatrics should engage with the government to ensure easy availability of injection vitamin A throughout the country.

1. Guimarães H,　Guedes MB,　Rocha G,　et al. Vitamin A in prevention of bronchopulmonary dysplasia. Curr Pharm Des.　2012; 18: 3101-13.

2. Rakshasbhuvankar AA, Simmer K, Patole SK, et al. Enteral vitamin A for reducing severity of bronchopulmonary dysplasia: A randomized trial. Pediatrics. 2021;147:e2020009985.