Department of International Health
Newborn Vitamin A Supplementation
and Early Infant Mortality:
Current Evidence
James Tielsch, Ph.D.
Bangkok, March 2010
Newborn Vitamin A Supplementation
Background
• Vitamin A supplementation well accepted intervention
for children 6 – 72 months of age.
• Evidence for children <6 m, suggested no impact on
child mortality.
• Newborn period (first few days) may be different:
• Almost all infants born with very low reserves.
• Breastfeeding women often vitamin A deficient.
• Trial in very preterm infants in US showed reduced
rate of BPD.
Randomized Trials in South and SE Asia
Study
Humphrey et al.
(1996)
Rahmathullah et
al. (2003)
Klemm et al.
(2009)
Country
Design
Indonesia
Hospital-based
individually randomized
trial
Community-based
India
individually randomized
trial
Presenter’s Name
Date
Bangladesh
Study Size
(Live Births)
Vit. A: 1034
Control:1033
Age at
Dosing
Mean = 16.4hrs
88.2% within 24
hrs
Vit. A: 5,786
Control: 5,833
Median = 26hrs
80% within 48
hrs
Community-based
cluster randomized trial
Vit. A:7.953
Control: 7,984
Median = 7hrs
84% within 48
hrs
Not completed
?
Bhutta et al.
(unfinished)
Pakistan
Community-base
cluster randomized trial
Vit. A: 180
clusters
Cont.: 180
clusters
?
(unfinished)
India
?
?
Randomized Trials in South and SE Asia
Study
Country
Results
Humphrey et al. (1996)
Indonesia
RR (IMR) =0.36
(0.16, 0.87)
Rahmathullah et al.
(2003)
India
RR (6m IMR) = 0.78
(0.63, 0.96)
Presenter’s Name
Date
Klemm et al. (2009)
Bangladesh
RR (6m IMR) =0.85
(0.73, 1.00)
POOLED
India &
Bangladesh
RR = 0.83
(0.72-0.94)
Pooled Results by Maternal Characteristics
Presenter’s Name
Date
Pooled Results by Infant Characteristics
Presenter’s Name
Date
Randomized Trials in Africa
Two trials in Africa have shown no impact of newborn
vitamin A supplementation on early infant mortality.
• Zimbabwe (HIV neg infants)
• No maternal vitamin A deficiency.
• Very low mortality rates.
• Guinea Bissau
• Little vitamin A deficiency
Presenter’s Name
• Combined with BCG vaccination
Date
• Provided care for sick infants.
• Other reasons ???
• Zambia trial just getting started.
• ? SHOULD DATA BE COMBINED WITH ASIAN TRIALS ?
Conclusions
• Trials from Asia provide strong evidence that
supplementation with 50,000 IU vitamin A within the first few
days after birth reduces early infant mortality in south &
southeast Asian settings.
• Waiting until 2 or more weeks after birth will likely have
little impact on mortality.
• Newborn vitamin A supplementation is unlikely to have an
Presenter’s Name
impact in settings with little maternal vitamin A deficiency
Date
and where early
infant mortality rates are already low.
• Newborn vitamin A supplementation is a highly costeffective intervention that can assist countries in meeting
MDG-4.