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. Design. 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 5 95) admitted to hospital with community-acquired pneumonia in Lima, Peru. Children 1 year of age received 200 000 IU on admission and 100 000 IU the next day. Results. Children receiving vitamin A (n 5 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 con- solidation (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 5 47). Adjustment for baseline severity of disease and nutritional status did not alter the associ- ation of vitamin A with increased clinical severity, al- though 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. Pediatrics 1998;101(5). URL: http:// www.pediatrics.org/cgi/content/full/101/5/e3; vitamin A, pneumonia, children, Peru, respiratory, lung, retinol.