Newborn Vitamin A Supplementation: Frequently Asked Questions

The intervention involves supplementing infants shortly after birth with a single, large oral dose of vitamin A (50,000 IU). Newborn infants are at risk for vitamin A deficiency due to low liver and total body stores of vitamin A at birth. Infants born to mothers with poor vitamin A status and low breast milk concentrations of vitamin A are particularly vulnerable to vitamin A deficiency. Studies have shown that newborn vitamin A supplementation can reduce infant mortality in Southern Asia. Three field trials in Indonesia, India, and Bangladesh reported significant reductions of 15% or more in infant mortality in the first six months of life. A meta-analysis based on these trials suggests that the risk of death from all causes in the first six months of life can be reduced by approximately 21% when newborns within the region are given a 50,000 IU oral dose of vitamin A. The timing of NVAS is critical, with evidence suggesting that infants should be dosed within the first two days of life to have a mortality impact. Data from the India trial showed no survival impact if infants were dosed after 14 days of age. There is also evidence that age at dosing influences the survival benefit of vitamin A in early infancy. While maternal postpartum vitamin A supplementation can improve breast milk retinol concentrations and temporarily improve infant vitamin A status, it appears insufficient to bring infants into adequate vitamin A status through six months of age. Direct dosing of infants with vitamin A is more likely to raise liver stores and improve infant vitamin A status. The biologic mechanisms by which newborn vitamin A intake could decrease infant mortality are not fully understood but are likely to involve the role of vitamin A in supporting postnatal organ and tissue development. Vitamin A is essential for early lung and airway tissue differentiation, growth, development, and immunity. Healthier lungs may provide a measure of protection against early infantile pneumonia. Evidence from short- and long-term studies suggests that the risk of acute side effects following oral delivery of 50,000 IU of vitamin A early in infancy is minimal. Slight increases in the rates of bulging fontanelle have been reported among infants less than six months of age dosed with vitamin A versus placebo. However, the "bulge" results from a mild expansion of cranial volume that subsides without increasing intracranial pressure. Administering the postpartum and neonatal dose of vitamin A at the same time is safe, according to evidence from two trials. In an HIV-positive population in Harare, Zimbabwe, and in South Asia, the incidence of reported side-effects was low and did not differ by group. The studies to date were designed to assess the impact of NVAS on mortality through six months of age and did not have a large enough sample size to examine the impact on neonatal mortality. However, the evidence suggests that NVAS can reduce infant mortality in Southern Asia, and further research is needed to determine its impact on neonatal mortality.