Neonatal vitamin A supplementation: effect on development and growth at 3 y of age.
What this study found
Neonatal vitamin A supplementation did not produce biologically significant adverse developmental or growth effects by age 3 and showed small possible developmental benefits. The treatment coefficient was positive in all 6 regression models, and orientation-engagement was significant (P = 0.04). In growth analyses, vitamin A in the normal-fontanelle group was associated with 0.68 cm more growth over the first 3 years (95% CI: 0.03, 1.33; P < 0.05), whereas the bulging-fontanelle group tended to grow 0.5 cm less (95% CI: -1.52, 0.52; P = 0.33). The treatment-by-fontanelle interaction was not…
- Study & population
- Randomized neonatal vitamin A trial with 3-year follow-up in Indonesian infants born at Hasan Sadikin Hospital in Bandung, Indonesia.
- Intervention
- A single oral neonatal dose of vitamin A was given on the first day of life at 52 mol, with 23 mol vitamin E.
- Key limitation
- The bulging-fontanelle subgroup was relatively small, limiting precision for subgroup comparisons.
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Open PDFOriginal abstract
We reported recently that neonatal supplementation with 52 micromol vitamin A reduced infant mortality by 64%; acute side effects were limited to a 3% excess rate of a bulging fontanelle. The current study was conducted to identify developmental changes at 3 y of age associated with neonatal vitamin A supplementation or a bulging fontanelle. Children who had a bulging fontanelle (n = 91) and 432 children who had normal fontanelles after receiving vitamin A or placebo were evaluated with the Bayley Scales of Infant Development. Mean scores for the mental, psychomotor, and behavioral rating scale (BRS) plus 3 subscales of the BRS were not significantly different for treatment-fontanelle-specific groups. In regression models predicting each score, a bulging fontanelle had a small negative effect in all models; when 1 child who was injured from birth was removed from the analysis the effect of a bulging fontanelle was not significant in any model (P > or = 0.35). Vitamin A supplementation had a small beneficial effect on all developmental scores, which was significant for one of the BRS subscales (orientation-engagement) and also for a second (motor quality) when the outlier child was removed. Compared with children with normal fontanelles in the placebo group, children with a bulging fontanelle in the vitamin A group tended to grow less (-0.5 cm, P = 0.33), whereas those with normal fontanelles in the vitamin A group grew significantly more (0.68 cm, P < 0.05), over the first 3 y of life. This study provides no evidence that neonatal vitamin A supplementation is associated with biologically significant adverse growth or developmental sequelae.