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Vitamin A for non-measles pneumonia in children
Insights
Vitamin A supplementation did not significantly reduce mortality or improve the clinical course of non-measles pneumonia in children. Low-dose vitamin A showed a reduction in recurrent bronchopneumonia rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Pneumonia is a leading cause of death in children under five in developing countries.
- Vitamin A supplementation has shown promise in reducing respiratory infection severity and mortality in children with measles.
Purpose of the Study:
- To evaluate the efficacy of adjunctive vitamin A in treating non-measles pneumonia in infants and children.
Main Methods:
- Systematic review and meta-analysis of parallel-arm, randomized, and quasi-randomized controlled trials.
- Searched multiple databases including CENTRAL, MEDLINE, EMBASE, LILACS, CINAHL, Biological Abstracts, Current Contents, and CBM.
- Included trials involving children under 15 with non-measles pneumonia treated with vitamin A.
Main Results:
- No significant reduction in pneumonia-related mortality or hospital stay duration was observed with vitamin A.
- Vitamin A was linked to a 39% reduction in first-line antibiotic failure and a decrease in recurrent bronchopneumonia with low-dose supplementation.
- High-dose vitamin A was associated with worse disease severity, while common side effects like vomiting and diarrhea were not significantly increased.
Conclusions:
- Adjunctive vitamin A treatment did not demonstrate significant benefits in reducing mortality or improving morbidity in children with non-measles pneumonia.
- Limitations include potential lack of statistical power due to variations in outcome measurement across studies.
- Low-dose vitamin A may be beneficial for reducing recurrent bronchopneumonia.
Background:
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.
Objectives:
To determine whether adjunctive vitamin A is effective in infants and children diagnosed with non-measles pneumonia.
Search Strategy:
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).
Selection Criteria:
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.
Data Collection And Analysis:
Two authors independently extracted data and assessed trial quality. Study authors were contacted for additional information.
Main Results:
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).
Authors' Conclusions:
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.
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