The effect of neonatal vitamin A supplementation on growth in the first year of life among low-birth-weight infants in Guinea-Bissau: two by two factorial randomised controlled trial

Sofie Biering-Sørensen,Ane Bærent Fisker,Ivan Monteiro,Henrik Ravn,Peter Aaby,Luis Camala,Christine Stabell Benn

doi:10.1186/1471-2431-13-87

Sofie Biering-Sørensen, Ane Bærent Fisker + Show 5 more

Open Access

https://doi.org/10.1186/1471-2431-13-87

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Journal: BMC Pediatrics	Publication Date: May 23, 2013
Citations: 27	License type: CC BY 2.0

Affiliation: Bandim Health Project, Statens Serum Institut

Abstract

BackgroundVitamin A supplementation (VAS) may amplify the effect of vaccines. We therefore investigated if neonatal VAS given with and without Bacille Calmette-Guérin (BCG) vaccine to low-birth-weight (LBW) neonates had an effect on growth in the first year of life. We hypothesised that VAS would be particularly beneficial when provided with BCG.MethodsWe conducted a randomised two-by-two factorial trial in Guinea-Bissau; 1,717 LBW neonates were randomly allocated to VAS or placebo at birth as well as early or the usual postponed BCG vaccination. Anthropometric measurements were obtained at 2, 6, and 12 months after inclusion.ResultsOverall there was no effect of neonatal VAS on growth in the first year of life. By 2 months, VAS tended to have a beneficial effect on weight and head circumference when given with BCG but not when given without BCG (interaction: weight-for-age p = 0.07 and head circumference-for-age: p = 0.06). By 6 months, there was a beneficial effect of VAS on head circumference and weight among children who had not received DTP vaccine 2 months after inclusion (weight: 0.18 (0.00; 0.36) and head circumference 0.27 (0.06; 0.48)), but no beneficial effect among those who had received DTP.ConclusionThe results support other trials indicating that neonatal VAS does not have consistent effects on childhood growth and if anything the effects seem to be temporary. They also show that the effect may differ by vaccination status, being beneficial when given with BCG at birth and when DTP is delayed.Trial registrationhttp://www.ClinicalTrials.gov (NCT00168610) (nct00168610)

Highlights

Vitamin A supplementation (VAS) may amplify the effect of vaccines
Overall there was no difference in weight, length and head circumference between the VAS and placebo groups 2 months after enrolment adjusted for baseline anthropometric measurements and randomisation to Bacille Calmette-Guérin (BCG)
The effect of VAS on head circumferencefor-age tended to differ with whether given with or without BCG; the effect of VAS was beneficial when given with BCG (0.16 (0.00; 0.32)), but not when VAS was given without BCG (−0.06 (−0.22; 0.10))

Summary

Introduction

We investigated if neonatal VAS given with and without Bacille Calmette-Guérin (BCG) vaccine to low-birth-weight (LBW) neonates had an effect on growth in the first year of life. Observational studies have shown that low dietary vitamin A intake and vitamin A deficiency are associated with impaired childhood growth [1,2,3]. An Indonesian study including only children with a birth weight ≥ 1500 g found an increase in length at 3 years of age among VAS recipients [6]. Another study conducted in Guinea-Bissau among normal-birth-weight infants (NBW; ≥ 2,500 g) found a positive effect on weight-for-length as long as Bacille Calmette-Guérin (BCG) vaccine was the most recent vaccine. None of the trials included children with very low birth weight, who are known to have poorer vitamin A status [8,9]

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