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Open Access Research article

The effect of neonatal vitamin A supplementation on growth in the first year of life among low-birth-weight infants in Guinea-Bissau: two by two factorial randomised controlled trial

Sofie Biering-Sørensen12*, Ane Bærent Fisker12, Henrik Ravn1, Luis Camala3, Ivan Monteiro2, Peter Aaby2 and Christine Stabell Benn1

Author Affiliations

1 Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, Copenhagen S 2300, Denmark

2 Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau

3 Maternidade, Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau

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BMC Pediatrics 2013, 13:87  doi:10.1186/1471-2431-13-87

Published: 23 May 2013

Abstract

Background

Vitamin A supplementation (VAS) may amplify the effect of vaccines. We therefore investigated if neonatal VAS given with and without Bacille Calmette-Guérin (BCG) vaccine to low-birth-weight (LBW) neonates had an effect on growth in the first year of life. We hypothesised that VAS would be particularly beneficial when provided with BCG.

Methods

We conducted a randomised two-by-two factorial trial in Guinea-Bissau; 1,717 LBW neonates were randomly allocated to VAS or placebo at birth as well as early or the usual postponed BCG vaccination. Anthropometric measurements were obtained at 2, 6, and 12 months after inclusion.

Results

Overall there was no effect of neonatal VAS on growth in the first year of life. By 2 months, VAS tended to have a beneficial effect on weight and head circumference when given with BCG but not when given without BCG (interaction: weight-for-age p = 0.07 and head circumference-for-age: p = 0.06). By 6 months, there was a beneficial effect of VAS on head circumference and weight among children who had not received DTP vaccine 2 months after inclusion (weight: 0.18 (0.00; 0.36) and head circumference 0.27 (0.06; 0.48)), but no beneficial effect among those who had received DTP.

Conclusion

The results support other trials indicating that neonatal VAS does not have consistent effects on childhood growth and if anything the effects seem to be temporary. They also show that the effect may differ by vaccination status, being beneficial when given with BCG at birth and when DTP is delayed.

Trial registration

http://www.ClinicalTrials.gov webcite (NCT00168610) (nct00168610)

Keywords:
Neonatal vitamin A supplementation; Low-birth-weight; Growth; Non-specific effects; DTP; BCG