Menu ENN Search

Neonatal vitamin A supplementation to prevent mortality and morbidity in infancy

Summary of published review1

A recently published review set out to evaluate the effect of neonatal vitamin A supplementation on infant mortality, morbidity and early adverse effects. It involved a systematic review, meta-analysis, and meta-regression of randomised controlled trials. It considered randomised or quasi-randomised or cluster randomised, placebo controlled trials evaluating the effect of prophylactic, neonatal (<1 month) supplementation with synthetic vitamin A on mortality or morbidity within infancy (<1 year), and early adverse effects ( 7 days).

To investigate mortality during infancy, six trials were included, four in Asia and two in Africa. Two cluster randomised trials were included with design adjusted results. All trials were double blind with adequate allocation concealment, and loss to follow-up was below 10% in four trials. Three trials followed up participants up to 6 months of age. Two trials gave simultaneous maternal postpartum vitamin A supplementation ( 30% mothers in the intervention arm). In all trials, the cumulative dose of vitamin A was 50 000 IU, given as a single dose in five trials and as two doses in one trial. Information on prevalence of maternal night blindness was available in only three trials; of these, one recorded a prevalence <5%. Mortality during the neonatal period was pooled in three trials, two from Asia and one from Africa. Data from the African trial pertained to the first seven days of life only. In the factorial design study, mothers in the placebo group received supplementation (synthetic vitamin A or _ carotene) identical to the intervention group. Cause specific mortality pooled data was ascertained by verbal autopsy from four trials, two each from Africa and Asia.

Specific limitations included: all the trials were conducted in developing countries, which limits the generalisation of findings. There were limited data on high risk groups (maternal night blindness 5% and low birth weight infants). In the two cluster randomised trials, adverse effects were unadjusted for design effect. Duration of follow-up was variable. Multiple subgroup and meta-regression analyses were used, which increased the possibility of false positive results.

Conclusions

The authors found no evidence of a reduced risk of mortality during infancy (relative risk 0.92, 95% confidence interval 0.75 to 1.12, P=0.393 random effect; I2=54.1%) or of an increase in early adverse effects, including bulging fontanelle (1.16, 0.81 to 1.65, P=0.418; I2=65.3%). No variable emerged as a significant predictor of mortality, but data for important risk groups (high maternal night blindness prevalence and low birth weights) were restricted. Limited data (from one to four trials) did not indicate a reduced risk of mortality during the neonatal period (0.90, 0.75 to 1.08, P=0.270; I2=0%), cause specific mortality, common morbidities (diarrhoea and others), and admission to hospital. There was, however, evidence of an increased risk of acute respiratory infection and a reduced risk of clinic visits.

The authors conclude there is no convincing evidence of a reduced risk of mortality and possibly morbidity or of increased early adverse effects after neonatal supplementation with vitamin A. They consider no justification for initiating such supplementation as a public health intervention in developing countries for reducing infant mortality and morbidity.

'Rapid responses' to this paper, at BMJ online, raised some questions. These included whether there is a heterogeneity in the effect of Vitamin A in different populations AND THE NEED FOR further investigation to identify what sub-group of infants might benefit from neonatal supplementation. Access the full article and view 'rapid responses' at: http://www.bmj.com/cgi/content/full/338/mar27_1/b919

Show footnotes

1Gogia S and Sachdev, HS (2009). Neonatal vitamin A supplementation for prevention of mortality and morbidity in infancy: systematic review of randomised controlled trials. BMJ 2009;338:b919

More like this

en-net: Is Folic Acid safe for malnourished children?

Dear All, In the light of the short [url=http://nutritionfacts.org/video/can-folic-acid-be-harmful/]video[/url] listed below and the scientific article cited in the same...

FEX: Effects of nutrition interventions during pregnancy on low birth weight

Summary of research1 Location: Global What we know: Low birth weight (LBW) is a major underlying cause of infant mortality and childhood morbidity; LBW is greatly affected by...

FEX: Large-scale intervention to introduce orange sweet potato in Mozambique increases vitamin A intake

Summary of research1 Location: Mozambique What we know: Vitamin A deficiency is associated with increased risk of morbidity and mortality and ocular disorders in pregnant and...

FEX: Vitamin A policies need rethinking

Summary of research1 Location: Global What we know: Vitamin A deficiency (VAD) remains prevalent worldwide. Periodic (6 monthly) high dose distribution of VA has been the...

FEX: Summary of Lancet Series on Maternal and Child Undernutrition

Below are short summaries of the recently launched Lancet series of papers on Maternal and Child Undernutrition1. This high profile series focuses on the disease burden...

en-net: Vitamin A supplemntation for severe wasting

Is it contraindicated to give Viatamin A for severe wasting during admission given the child didn't received in the last six months? until recently, my information was not to...

Resource: Optimal breastfeeding practices and infant and child mortality

A Systematic Review and Meta-analysis Breastfeeding is one of the few interventions where the survival benefits span the entire continuum of childhood: newborn, infancy and...

FEX: Does nutritional supplementation for two weeks prevent malnutrition in ill children?

Summary of research1 Location: DRC, Uganda and Nigeria What we know: Ill children are at increased risk of malnutrition due to the infection-malnutrition cycle. What this...

FEX: Research Snapshots

The following provides a short summary of each of these important research studies. A fuller summary of each can be found online at www.ennonline.net/fex Inpatient management...

FEX: Effect of short-term supplementation with ready-to-use therapeutic food or micronutrients for children after illness for prevention of malnutrition: a randomised controlled trial in Uganda

Summary of research1 Location: Uganda What we know: The potential for nutritional supplementation of sick children as a strategy for preventing malnutrition has not been...

FEX: Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

Summary of research1 Location: Global What we know: The decision not to breastfeed a child impacts on the health, nutrition and development of a child and on women's...

FEX: Treatment of SAM and MAM in low- and middle-income settings: a systematic review

Summary of research1 Location: Global What we know: Worldwide, 33 million children under 5 years are moderately malnourished and 19 million are severely malnourished. The...

en-net: Relationship between vitamin A deficiency and stunting

Dear All,

Would you help me to find out the answer to the below two question?

Is there any causal relationship between vitamin A deficiency and the greater risk...

FEX: Effect of short-term RUTF distribution on children in Niger

Summary of published research1 Mothers and children arriving for their monthly surveillance visits, as part of the trial Researchers from the Harvard School of Public Health...

FEX: Infant Feeding Patterns and Risk of Death

Summary of published paper1 Current WHO guidelines recommend that HIV positive mothers should avoid breastfeeding only if replacement feeding is acceptable, feasible,...

FEX: Early initiation of breastfeeding reduces neonatal mortality

Summary of published research1 A recently published study assessed the contribution of the timing of initiation of breastfeeding to neonatal death. The study also set out to...

FEX: Do children with uncomplicated severe acute malnutrition need antibiotics?

Summary of review1 Location: Multi-country review What we know already: Current WHO guidelines recommend routine antibiotics for all children with severe acute malnutrition...

FEX: Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition in Burkina Faso

Summary of research1 Location: Burkina Faso What we know: There is no consensus on the effectiveness of lipid-nutrient supplement (LNS) compared to corn-soy blend (CSB) in...

FEX: Independent and combined effects of improved WASH and improved complementary feeding on child stunting and anaemia in rural Zimbabwe

Summary of research1 Location: Zimbabwe What we know: Stunting and anaemia remain prevalent in children; plausible interventions have shown limited or inconsistent...

FEX: Nutrition and brain development in early life

Summary of review1 Location: Global What we know: It is likely that nutrition deficiency during pregnancy and early childhood affects individual cognition, behaviour, long...

Close

Reference this page

Neonatal vitamin A supplementation to prevent mortality and morbidity in infancy. Field Exchange 36, July 2009. p5. www.ennonline.net/fex/36/neonatal