Impact of neonatal vitamin A supplementation on infant morbidity and mortality,☆☆,,★★

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Abstract

OBJECTIVE: To determine whether vitamin A supplementation at birth could reduce infant morbidity and mortality. STUDY DESIGN: We conducted a placebo-controlled trial among 2067 Indonesian neonates who received either 52 μmol (50,000 IU) orally administered vitamin A or placebo on the first day of life. Infants were followed up at 1 year to determine the impact of this intervention on infant mortality. A subgroup (n = 470) was also examined at 4 and 6 months of age to examine the impact on morbidity. RESULTS: Vital status was confirmed in 89% of infants in both groups at 1 year. There were 19 deaths in the control group and 7 in the vitamin A group (relative risk = 0.36; 95% confidence interval = 0.16, 0.87). The impact was stronger among boys, infants of normal compared with low birth weight, and those of greater ponderal index. Among infants examined at 4 months of age, the 1-week period prevalence of common morbidities was similar for vitamin A and control infants. However, during this same 4-month period, 73% and 51% more control infants were brought for medical treatment for cough (p =0.008) and fever (p = 0.063), respectively. CONCLUSIONS: Neonatal vitamin A supplementation may reduce the infant mortality rate and the prevalence of severe respiratory infection among young infants. (J PEDIATR 1996;128:489-96)

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.

References (39)

  • FACS Campos et al.

    Effect of an infection on vitamin A status of children as measured by the relative dose response (RDR)

    Am J Clin Nutr

    (1987)
  • CB Stephensen et al.

    Vitamin A is excreted in the urine during acute infection

    Am J Clin Nutr

    (1994)
  • EM Pao et al.

    Milk intakes and feeding patterns of breast-fed infants

    J Am Diet Assoc

    (1980)
  • G. Dennert

    Retinoids and the immune system: immunostimulation by vitamin A

  • GH Beaton et al.

    Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries

    (1993)
  • JA. Olson

    Liver vitamin A reserves of neonates, preschool children and adults dying of various causes in Salvador, Brazil

    Arch Latinoam Nutr

    (1979)
  • JC Wallingford et al.

    Vitamin A deficiency in pregnancy, lactation, and the nursing child

  • de Francisco A, Yasui Y, Chakraborty J. Vitamin A supplementation given to mothers after delivery reduces infant...
  • A. Sommer

    Field guide to the detection and control of xerophthalmia

    (1982)
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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.

    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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