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Meta-Analysis
. 2005 Jul 20;2005(3):CD003700.
doi: 10.1002/14651858.CD003700.pub2.

Vitamin A for non-measles pneumonia in children

J Ni, J Wei, T Wu
Meta-Analysis

Vitamin A for non-measles pneumonia in children

J Ni et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute respiratory infections, mostly in the form of pneumonia, are the leading causes of death in children under five years of age in developing countries. Some clinical trials have demonstrated that vitamin A supplementation reduces the severity of respiratory infection and mortality in children with measles.

Objectives: To determine whether adjunctive vitamin A is effective in infants and children diagnosed with non-measles pneumonia.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004); MEDLINE (1996 to November Week 3, 2004); EMBASE (1990 to September 2004); LILACS (9 January 2004); CINAHL (1990 to November 2004); Biological Abstracts (1990 to November 2004) and Current Contents (1990 to September 2004); and the Chinese Biomedicine Database (CBM) (1994 to November 2004).

Selection criteria: Only parallel-arm, randomised and quasi-randomised controlled trials in which children (younger than 15 years old) with non-measles pneumonia were treated with adjunctive vitamin A were included.

Data collection and analysis: Two authors independently extracted data and assessed trial quality. Study authors were contacted for additional information.

Main results: Five trials involving 1453 infants and children were included. There was no significant reduction in the mortality associated with pneumonia in children treated with vitamin A compared to those who were not (pooled odds ratio (OR) 1.49; 95% confidence interval (CI) 0.66 to 3.35). In addition, there was a lack of a statistically significant effect on duration of stay in hospital (weighted mean difference (WMD) 0.08; 95% CI -0.43 to 0.59). Vitamin A was associated with a 39% reduction in antibiotic firstline failure (OR 0.65; 95% CI 0.42 to 1.01). Children receiving vitamin A were no more likely to experience vomiting (OR 0.77; 95% CI 0.45 to 1.33), diarrhoea (OR 0.57; 95% CI 0.31 to 1.05), bulging of the fontanelles (OR 8.25; 95% CI 0.44 to 155.37) or irritability (OR 0.93, 95% CI 0.56 to 1.57) than those not receiving vitamin A. There was no statistical significance between vitamin A and placebo groups (OR 0.90; 95% CI -1.10 to 2.90) in chest x-ray results. Disease severity after supplementary high-dose vitamin A was significantly worse in children who received vitamin A compared with placebo. Low-dose vitamin A was associated with a significant reduction in the recurrent rate of bronchopneumonia (OR 0.12; 95% CI 0.03 to 0.46).

Authors' conclusions: The evidence did not suggest a significant reduction with vitamin A adjunctive treatment in mortality, measures of morbidity, nor an effect on the clinical course of pneumonia in children with non-measles pneumonia. However, not all studies measured all outcomes, limiting the number of studies that could be incorporated into the meta-analyses, so that there may have been a lack of statistical power to detect statistically significant differences.

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Conflict of interest statement

None known.

Figures

1
1
Search strategy in the Chinese databases.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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4
Forest plot of comparison: 1 Vitamin A versus control, outcome: 1.1 Mortality during hospitalisation.
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5
Forest plot of comparison: 1 Vitamin A versus control, outcome: 1.2 Time with signs of pneumonia and treatment issues (continuous).
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6
Forest plot of comparison: 1 Vitamin A versus control, outcome: 1.3 Time with signs of pneumonia and treatment issues (dichotomous).
7
7
Forest plot of comparison: 1 Vitamin A versus control, outcome: 1.5 Time with fever, tachypnoea and hypoxaemia of pneumonia (serum retinol > 200 ug/L).
8
8
Forest plot of comparison: 1 Vitamin A versus control, outcome: 1.4 Adverse events.
9
9
Primary outcomes
10
10
Secondary outcomes
11
11
Adverse events and secondary outcome
1.1
1.1. Analysis
Comparison 1 Vitamin A versus control, Outcome 1 Mortality during hospitalisation.
1.2
1.2. Analysis
Comparison 1 Vitamin A versus control, Outcome 2 Time with signs of pneumonia and treatment issues (continuous).
1.3
1.3. Analysis
Comparison 1 Vitamin A versus control, Outcome 3 Time with signs of pneumonia and treatment issues (dichotomous).
1.4
1.4. Analysis
Comparison 1 Vitamin A versus control, Outcome 4 Adverse events.
1.5
1.5. Analysis
Comparison 1 Vitamin A versus control, Outcome 5 Time with fever, tachypnoea and hypoxaemia of pneumonia (serum retinol > 200 ug/L).
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