Newborn vitamin A supplementation reduced infant mortality in rural Bangladesh.
OBJECTIVE
We assessed the effect of supplementing newborns with 50000 IU of vitamin A on all-cause infant mortality through 24 weeks of age.


METHODS
This was a community-based, double-masked, cluster-randomized, placebo-controlled trial conducted in 19 unions in rural northwest Bangladesh. The study was nested into and balanced across treatment arms of an ongoing placebo-controlled, weekly maternal vitamin A or beta-carotene supplementation trial. Study-defined sectors (N = 596) were evenly randomized for newborns of participating mothers to receive a single, oral supplement of vitamin A (50000 IU) or placebo as droplets of oil squeezed from a gelatinous capsule. Mothers provided informed consent for newborn participation at approximately 28 weeks' gestation. After birth, typically at home (where >90% of births occurred), infants were supplemented and their vital status was followed through 24 weeks of age. The main outcome measure was mortality through 24 weeks of age.


RESULTS
We obtained maternal consent to dose 17116 live-born infants (99.8% of all eligible) among whom 15937 (93.1%) were visited to be supplemented <30 days after birth and for whom vital status at 24 weeks of age was known. Dosed infants (n = 15902 [99.8%]) received their study supplement at a median age of 7 hours. Relative to control subjects, the risk of death in vitamin A-supplemented infants was 0.85, reflecting a 15% reduction in all-cause mortality. Protective relative risks were indistinguishable by infant gender, gestational age, birth weight, age at dosing, maternal age, parity, or across the 3 treatment arms of the maternal supplementation trial.


CONCLUSIONS
Newborn vitamin A dosing improved infant survival through the first 6 months of life in Bangladesh. These results corroborate previous findings from studies in Indonesia and India and provide additional evidence that vitamin A supplementation shortly after birth can reduce infant mortality in South Asia.
Klemm
Rolf D W
RD
DrPH, Johns Hopkins University, Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205. rklemm@jhsph.edu.
Labrique
Alain B
AB
Christian
Parul
P
Rashid
Mahbubur
M
Shamim
Abu Ahmed
AA
Katz
Joanne
J
Sommer
Alfred
A
West
Keith P
KP
D001459:Bangladesh; D001942:Breast Feeding / Q000706:statistics & numerical data; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007224:Infant Care; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D019035:Rural Health Services; D012424:Rural Population; D014801:Vitamin A / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage*
D014815:Vitamins; D014801:Vitamin A