Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Mar 27:338:b919.
doi: 10.1136/bmj.b919.

Neonatal vitamin A supplementation for prevention of mortality and morbidity in infancy: systematic review of randomised controlled trials

Siddhartha Gogia  1 , Harshpal Singh Sachdev
Affiliations

Neonatal vitamin A supplementation for prevention of mortality and morbidity in infancy: systematic review of randomised controlled trials

Siddhartha Gogia et al. BMJ. .

Abstract

Objective: To evaluate the effect of neonatal vitamin A supplementation on infant mortality, morbidity and early adverse effects.

Design: Systematic review, meta-analysis, and meta-regression of randomised controlled trials.

Data sources: Electronic databases and hand search of reviews; abstracts and proceedings of conferences. Review methods 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).

Results: The six included trials were from developing countries. There was no convincing 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; I(2)=54.1%) or of an increase in early adverse effects including bulging fontanelle (1.16, 0.81 to 1.65, P=0.418; I(2)=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; I(2)=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.

Conclusions: 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. There is thus no justification for initiating such supplementation as a public health intervention in developing countries for reducing infant mortality and morbidity.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Trial flow for selection of randomised controlled trials for inclusion in meta-analysis
None
Fig 2 Forest plots for relative risk of mortality during infancy
See this image and copyright information in PMC

References

    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003;362:65-71. - PubMed
    1. Glasizou PP, Mackerras DEM. Vitamin A supplementation in infectious diseases: a meta-analysis. BMJ 1993;306:366-70. - PMC - PubMed
    1. Beaton GH, Martorell R, Aronson KJ, Edmonston B, McCabe G, Ross AC, et al. Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. Geneva: ACC/SCN State of the Art Series, 1993. (Nutrition Policy Discussion Paper No 13.)
    1. Fawzi WW, Chalmers TC, Herrera MG, Mosteller F. Vitamin A supplementation and child mortality. JAMA 1993;269:898-903. - PubMed
    1. Rahmathullah L, Underwood BA, Thulsiraj RD, Milton RC, Ramaswamy K, Rahmathullah R, et al. Reduced mortality among children in Southern India receiving a small weekly dose of vitamin A. N Engl J Med 1990;323:929-35. - PubMed

Publication types