Impact of neonatal vitamin A supplementation on infant morbidity and mortality☆,☆☆,★,★★
Section snippets
Study population and field methods
All infants born at Hasan Sadikin Hospital in Bandung, Indonesia, from June 18, 1992, to June 3, 1993, were considered for enrollment. Very low birth weight infants (<1500 gm) and those with life-threatening illness were excluded. Of the 2844 eligible live births, written informed parental consent was given within the 24-hour inclusionary period for 2067 infants (73%) who were enrolled. Baseline evaluations were conducted by a team of 12 nurse midwives and 4 pediatricians. After stratification
RESULTS
Of the 2067 infants, vital status could be confirmed for 1839 (89%) at 1 year of age (mean [SD] = 366 [32] days; range = 299 to 488 days). Of these, 1636 (89.0%) either had died or were examined by a study nurse at 12 months; the remaining 203 infants (11.0%) were not home during the 12-month visit, but vital status and other information could be obtained from a family member or other informed historian. Follow-up was similar in the two treatment groups (89.5% in the vitamin A group and 88.5%
DISCUSSION
In this study, a single 52 μmol dose of vitamin A administered to neonates on the first day of life significantly reduced their risk of dying during infancy. Consistent with previous reports, vitamin A supplementation had little impact on the prevalence of common illnesses reported in a 1-week history.17, 18 However, the intervention reduced health care visits associated with cough and fever (a symptom and sign of pneumonia, the leading cause of death among young infants19, 20, 21) during the
Acknowledgements
We extend our thanks and appreciation to the dedicated team of study nurses at Hasan Sadikin Hospital, especially their supervisors Ibu Anima and Ibu Rukmini, and thank Drs. Robert Black and Mark Steinhoff for assistance in developing the verbal autopsy instrument. We also give tribute to Dr. Wenas Ngantung, who expertly managed the data and who died shortly after the study was completed.
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From the Division of Human Nutrition, Department of International Health, School of Hygiene and Public Health and School of Medicine, Johns Hopkins University, Baltimore, Maryland, and the Faculty of Medicine, Department of Obstetrics and Gynecology and Department of Pediatrics, Padjadjaran University and Hasan Sadikin Hospital, Bandung, Indonesia
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Supported by Cooperative Agreement No. DAN-0045-A-5049 between the Center for Human Nutrition/Dana Center for Preventive Ophthalmology, Johns Hopkins University, and the Bureau of Research and Development, Office of Nutrition, U.S. Agency for International Development, Washington, D.C., and grant No. S10-RR-04060 from the National Institutes of Health, with assistance from Task Force Sight and Life, Hoffmann-LaRoche, Basel, Switzerland.
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Reprint requests: Jean H. Humphrey, ScD, Department of International Health, Division of Human Nutrition, Hygiene Room 2041, 615 N. Wolfe St., Baltimore, MD 21205-2179.
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0022-3476/96/$5.00 + 0 9/20/70940