Vitamin A for non-measles pneumonia in children

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Abstract
Acute respiratory infections, mostly in the form of pneumonia, are the leading causes of death in children under five years of age in developing countries. Some clinical trials have demonstrated that vitamin A supplementation reduces the severity of respiratory infection and mortality in children with measles. To determine whether adjunctive vitamin A is effective in infants and children diagnosed with non-measles pneumonia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004); MEDLINE (1996 to November Week 3, 2004); EMBASE (1990 to September 2004); LILACS (9 January 2004); CINAHL (1990 to November 2004); Biological Abstracts (1990 to November 2004) and Current Contents (1990 to September 2004); and the Chinese Biomedicine Database (CBM) (1994 to November 2004). Only parallel-arm, randomised and quasi-randomised controlled trials in which children (younger than 15 years old) with non-measles pneumonia were treated with adjunctive vitamin A were included. Two authors independently extracted data and assessed trial quality. Study authors were contacted for additional information. Five trials involving 1453 infants and children were included. There was no significant reduction in the mortality associated with pneumonia in children treated with vitamin A compared to those who were not (pooled odds ratio (OR) 1.49; 95% confidence interval (CI) 0.66 to 3.35). In addition, there was a lack of a statistically significant effect on duration of stay in hospital (weighted mean difference (WMD) 0.08; 95% CI -0.43 to 0.59). Vitamin A was associated with a 39% reduction in antibiotic firstline failure (OR 0.65; 95% CI 0.42 to 1.01). Children receiving vitamin A were no more likely to experience vomiting (OR 0.77; 95% CI 0.45 to 1.33), diarrhoea (OR 0.57; 95% CI 0.31 to 1.05), bulging of the fontanelles (OR 8.25; 95% CI 0.44 to 155.37) or irritability (OR 0.93, 95% CI 0.56 to 1.57) than those not receiving vitamin A. There was no statistical significance between vitamin A and placebo groups (OR 0.90; 95% CI -1.10 to 2.90) in chest x-ray results. Disease severity after supplementary high-dose vitamin A was significantly worse in children who received vitamin A compared with placebo. Low-dose vitamin A was associated with a significant reduction in the recurrent rate of bronchopneumonia (OR 0.12; 95% CI 0.03 to 0.46). The evidence did not suggest a significant reduction with vitamin A adjunctive treatment in mortality, measures of morbidity, nor an effect on the clinical course of pneumonia in children with non-measles pneumonia. However, not all studies measured all outcomes, limiting the number of studies that could be incorporated into the meta-analyses, so that there may have been a lack of statistical power to detect statistically significant differences.