Adverse effects of high-dose vitamin A supplements in children hospitalized with pneumonia.
OBJECTIVE
To test the hypothesis that high-dose vitamin A supplements will enhance recovery of children hospitalized for the treatment of community-acquired pneumonia.


METHODS
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.
Stephensen
C B
CB
Department of International Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Franchi
L M
LM
Hernandez
H
H
Campos
M
M
Gilman
R H
RH
Alvarez
J O
JO
D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy; D019587:Dietary Supplements / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D014801:Vitamin A / Q000008:administration & dosage / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D014801:Vitamin A; D010100:Oxygen