High dose vitamin A supplementation in the course of pneumonia in Vietnamese children

Si, N. V.; Grytter, Carl; Vy, N. N. T.; Hue, Nguyen Bach; Pedersen, F. K.

doi:10.1111/j.1651-2227.1997.tb14805.x

Cited by 34 publications

(46 citation statements)

References 20 publications

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“…The effect of vitamin A on respiratory infections has been examined in several randomized clinical trials, with varying results. Most hospital-based studies on vitamin A supplementation and the severity of pneumonia have not shown significant overall effects (36,41,74,97,139), as recently reviewed by Brown and Roberts (21). In fact, some of the hospital-based studies suggest an apparent increase in indicators of severity associated with vitamin A supplementation (41,85,105,146).…”

Section: Vitamin a Supplementation And Clinical Outcomesmentioning

confidence: 78%

Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

2005

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Vitamin A supplementation to preschool children is known to decrease the risks of mortality and morbidity from some forms of diarrhea, measles, human immunodeficiency virus (HIV) infection, and malaria. These effects are likely to be the result of the actions of vitamin A on immunity. Some of the immunomodulatory mechanisms of vitamin A have been described in clinical trials and can be correlated with clinical outcomes of supplementation. The effects on morbidity from measles are related to enhanced antibody production and lymphocyte proliferation. Benefits for severe diarrhea could be attributable to the functions of vitamin A in sustaining the integrity of mucosal epithelia in the gut, whereas positive effects among HIV-infected children could also be related to increased T-cell lymphopoiesis. There is no conclusive evidence for a direct effect of vitamin A supplementation on cytokine production or lymphocyte activation. Under certain circumstances, vitamin A supplementation to infants has the potential to improve the antibody response to some vaccines, including tetanus and diphtheria toxoids and measles. There is limited research on the effects of vitamin A supplementation to adults and the elderly on their immune function; currently available data provide no consistent evidence for beneficial effects. Additional studies with these age groups are needed

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Section: Vitamin a Supplementation And Clinical Outcomesmentioning

confidence: 78%

Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

2005

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“…They all used a placebo group to compare the results and severely malnourished children were most of the time excluded. Except in one study (Julien et al, 1999), no benefits of VA supplementation were reported (Kjolhede et al, 1995;Nacul et al, 1997;Si et al, 1997;Fawzi et al, 1998;Mahalabanis et al, 2004). Adverse effects of high-dose VA were reported in two studies (Stephensen et al, 1998;Fawzi et al, 2000).…”

Section: Discussionmentioning

confidence: 96%

“…In Vietnam, moderately malnourished VA-supplemented children had a significantly shorter time of hospitalization (Si et al, 1997).…”

Section: Discussionmentioning

confidence: 96%

“…In contrast, clinical trials that have examined the effect of high-dose VA supplementation on diarrhoea and respiratory infections in children not infected with measles showed either no effects (Henning et al, 1992;Kjolhede et al, 1995;Nacul et al, 1997;Donnen et al, 1998;Fawzi et al, 1998;Faruque et al, 1999) or only small ones (Dewan et al, 1995;Si et al, 1997;Hossain et al, 1998;Julien et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Effect of daily low dose of vitamin A compared with single high dose on morbidity and mortality of hospitalized mainly malnourished children in senegal: a randomized controlled clinical trial

et al. 2007

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Background: In vitamin A-deficient populations, children hospitalized with infections and/or malnutrition are at particular risk of developing severe vitamin A (VA) deficiency. High-dose VA supplements are recommended as part of the treatment but results on its effect on recovery from morbidity and on prevention from nosocomial morbidity are conflicting. Objective: We aimed to assess the effect of a single high dose and daily low dose of VA on hospitalized malnourished children's morbidity. Design: We carried out a double-blind, randomized trial in 604 and 610 Senegalese hospitalized children. The first mentioned batch received a high-dose VA supplement (200 000 IU) on admission, the second a daily low-dose VA supplement (5000 IU per day) during hospitalization. Children were followed up until discharged. Data on all-cause morbidity were collected daily. Results: Survival analysis showed that the incidence of respiratory disease was significantly lower in the low-dose group than in the high-dose group, hazard ratios (HR): 0.26, 95% CI: 0.07-0.92. The duration of respiratory infection was also significantly lower in the low-dose group than in the high-dose group (HR of cure: 1.41, 95% CI: 1.05-1.89). Duration and incidence of diarrhoea were not significantly different between treatment groups. In children with oedema on admission, mortality was significantly lower in the low-dose group (Adjusted odds ratio: 0.21; 95% CI: 0.05-0.99). Conclusions: Daily low dose of VA compared with single high dose significantly reduced duration and incidence of respiratory infection but not of diarrhoea in hospitalized children.

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“…Two additional placebo-controlled studies using higher doses of oilbased vitamin A (400 000 IU over 2 days in children Ͼ1 year of age and half this dose in younger subjects) have been completed recently in Brazil 12 and Vietnam. 13 In Brazil, 472 inpatients and outpatients 6 months to 5 years of age with a clinical diagnosis of pneumonia were studied. Fever, respiratory rate, and blood oxygen saturation were monitored daily in inpatients and on days 3 and 11 in outpatients.…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects of High-dose Vitamin A Supplements in Children Hospitalized With Pneumonia

et al. 1998

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ABSTRACT.Objective. To test the hypothesis that high-dose vitamin A supplements will enhance recovery of children hospitalized for the treatment of communityacquired pneumonia.Design. We conducted a randomized, double-blind, placebo-controlled clinical trial of high-dose vitamin A supplements among children 3 months to 10 years of age (N ‫؍‬ 95) admitted to hospital with community-acquired pneumonia in Lima, Peru. Children <1 year of age received 100 000 IU of water-miscible vitamin A on admission to the hospital and an additional 50 000 IU the next day. Children >1 year of age received 200 000 IU on admission and 100 000 IU the next day.Results. Children receiving vitamin A (n ‫؍‬ 48) had lower blood oxygen saturation (the mean difference on day 3 in hospital was 1.1%), higher prevalence rates of retractions (37% in the vitamin A group vs 15% in the placebo group on day 3), auscultatory evidence of consolidation (28% in the vitamin A group vs 17% in the placebo group on day 3), and were more likely to require supplemental oxygen (21% in the vitamin A group vs 8% in the placebo group on day 3) than children in the placebo group (n ‫؍‬ 47). Adjustment for baseline severity of disease and nutritional status did not alter the association of vitamin A with increased clinical severity, although the difference in blood oxygen saturation was no longer statistically significant. No differences were seen in duration of hospitalization or in chest x-ray changes 14 days after admission. No deaths occurred, and toxicity of vitamin A was not seen.Conclusions. This study indicates that high-dose vitamin A supplements cause modest adverse effects in children recovering from pneumonia and should not be used therapeutically in such patients unless there is clinical evidence of vitamin A deficiency or concurrent measles infection. Pediatrics 1998;101(5). URL: http:// www.pediatrics.org/cgi/content/full/101/5/e3; vitamin A, pneumonia, children, Peru, respiratory, lung, retinol.ABBREVIATIONS. UPCH, Universidad Peruana Cayetano Heredia; PPD, purified protein derivative; ANOVA, analysis of variance; SD, standard deviation; RSV, respiratory syncytial virus.

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High dose vitamin A supplementation in the course of pneumonia in Vietnamese children

Cited by 34 publications

References 20 publications

Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

Effect of daily low dose of vitamin A compared with single high dose on morbidity and mortality of hospitalized mainly malnourished children in senegal: a randomized controlled clinical trial

Adverse Effects of High-dose Vitamin A Supplements in Children Hospitalized With Pneumonia

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