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Neonatal vitamin A supplementation for prevention of mortality and morbidity in infancy: systematic review of randomised controlled trials

BMJ 2009; 338 doi: (Published 27 March 2009) Cite this as: BMJ 2009;338:b919
  1. Siddhartha Gogia, attending consultant,
  2. Harshpal Singh Sachdev, senior consultant
  1. 1Department of Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110016, India
  1. Correspondence to: H S Sachdev, E-6/12 Vasant Vihar, New Delhi 110057, India hpssachdev{at}
  • Accepted 29 December 2008


Objective To evaluate the effect of neonatal vitamin A supplementation on infant mortality, morbidity and early adverse effects.

Design Systematic review, meta-analysis, and meta-regression of randomised controlled trials.

Data sources Electronic databases and hand search of reviews; abstracts and proceedings of conferences.

Review methods Randomised or quasi-randomised or cluster randomised, placebo controlled trials evaluating the effect of prophylactic, neonatal (<1 month) supplementation with synthetic vitamin A on mortality or morbidity within infancy (<1 year), and early adverse effects (≤7 days).

Results The six included trials were from developing countries. There was no convincing evidence of a reduced risk of mortality during infancy (relative risk 0.92, 95% confidence interval 0.75 to 1.12, P=0.393 random effect; I2=54.1%) or of an increase in early adverse effects including bulging fontanelle (1.16, 0.81 to 1.65, P=0.418; I2=65.3%). No variable emerged as a significant predictor of mortality, but data for important risk groups (high maternal night blindness prevalence and low birth weights) were restricted. Limited data (from one to four trials) did not indicate a reduced risk of mortality during the neonatal period (0.90, 0.75 to 1.08, P=0.270; I2=0%), cause specific mortality, common morbidities (diarrhoea and others), and admission to hospital. There was, however, evidence of an increased risk of acute respiratory infection and a reduced risk of clinic visits.

Conclusions There is no convincing evidence of a reduced risk of mortality and possibly morbidity or of increased early adverse effects after neonatal supplementation with vitamin A. There is thus no justification for initiating such supplementation as a public health intervention in developing countries for reducing infant mortality and morbidity.


  • We are grateful to Clive Osmond, MRC Epidemiology Resource Centre, University of Southampton, Southampton, for statistical advice.

  • Contributors: SG prepared the protocol, applied the search strategy, retrieved the articles, and extracted data. HSS developed the idea for review, finalised the protocol and search strategy, extracted data, and did the statistical analysis. Both authors wrote the final version of the paper and are guarantors.

  • Funding: This study was funded by Departments of Child and Adolescent Health and Development, and Nutrition for Health and Development, World Health Organization, Geneva. The funding source had no involvement in the study or the decision to publish the manuscript.

  • Competing interests: None declared.

  • Ethical approval: Not required.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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