COMMENTARY |
Department of Pediatrics, Baylor College of Medicine, Houston, Texas
Abbreviations: VAS, vitamin A supplementation
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IN THIS MONTH'S Pediatrics Electronic Pages, Klemm et al1 have provided new information that demonstrates a mortality benefit to neonatal vitamin A supplementation (VAS) in a developing country. Although nearly 100 years have passed since vitamin A was discovered, and more than 60 years since it was first synthesized, the precise mechanisms of its beneficial effects as a supplement remain to be elucidated. Beginning with trials reported in the 1980s,2 VAS in children
6 months of age has been accepted as a cost-effective intervention that is associated with a significant decrease in all-cause mortality in children aged 6 to 59 months in areas of highly prevalent vitamin A deficiency.3 It is estimated that in 1999 VAS prevented 242000 childhood deaths worldwide at an incremental cost of $64 per death averted and $0.02 per dose.4 Few significant adverse effects have been reported. VAS has been shown to be effective in reducing chronic lung disease in very low birth weight infants.5 However, not all studies have been positive; trials have shown no benefit of VAS in infants aged 1 to 5 months.6
The evidence for postnatal VAS in neonates born near term has been mixed. Klemm et al administered 50000 IU of vitamin A to infants within the first month of life in
Address correspondence to Steven A. Abrams, MD, Baylor College of Medicine, 1100 Bates St, Houston TX 77030. E-mail: sabrams@bcm.edu