PEDIATRICS Vol. 101 No. 5 May 1998, p. e3

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

Received Sep 8, 1997; accepted Dec 12, 1997.

Charles B. Stephensen^*, Luis Miguel Franchi, Herminio Hernandez, Miguel Campos^§, Robert H. Gilman^{, ¶, #}, and Jose O. Alvarez^*

From the ^* Department of International Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Departments of  Pediatrics, ^§ Mathematics, and  Pathology, Universidad Peruana Cayetano Heredia, Lima, Peru; ^¶ Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, Maryland; and ^# A.B. PRISMA, Lima, Peru.

Objective.  To test the hypothesis that high-dose vitamin A supplements will enhance recovery of children hospitalized for the treatment of community-acquired 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.

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