Neonatal vitamin A supplementation: effect on development and growth at 3 y of age.

Randomized neonatal vitamin A trial with 3-year follow-up in Indonesian infants born at Hasan Sadikin Hospital in Bandung, Indonesia. Children were analyzed by neonatal fontanelle status (bulging fontanelle versus normal fontanelle); infants with birth weight <1500 g or other life-threatening conditions were excluded.

A single oral neonatal dose of vitamin A was given on the first day of life at 52 mol, with 23 mol vitamin E. The comparison group received placebo containing vitamin E only.

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 significant, and some effects weakened after outlier exclusion. Overall, the findings support the safety of neonatal vitamin A supplementation.

The bulging-fontanelle subgroup was relatively small, limiting precision for subgroup comparisons. Several outcomes were borderline or lost significance after outlier exclusion, and the treatment-by-fontanelle interaction was not significant. Follow-up was limited to age 3 years, so longer-term effects were not assessed.