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Response of Bitot's spots in preschool children to vitamin A treatment
R D Semba1, S Wirasasmita, G Natadisastra
1Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute and School of Public Health, Johns Hopkins University, Baltimore, MD 21205.
Insights
Vitamin A supplementation effectively treats Bitot's spots in children, but some cases may not fully resolve, indicating normal vitamin A levels in a subset of affected individuals.
Area of Science:
- Nutritional Ophthalmology
- Public Health Nutrition
- Pediatric Clinical Trials
Background:
- Bitot's spots are a clinical sign historically associated with vitamin A deficiency.
- Accurate identification of vitamin A deficiency is crucial for effective public health interventions.
Purpose of the Study:
- To evaluate the efficacy of oral vitamin A supplementation in resolving Bitot's spots in preschool children.
- To investigate baseline vitamin A status in children presenting with Bitot's spots and assess treatment response.
Main Methods:
- A double-masked, placebo-controlled clinical trial was conducted in Indonesia.
- 88 preschool children (36-72 months) with Bitot's spots received either 200,000 IU oral vitamin A or placebo for five weeks.
- Serum vitamin A levels were measured at baseline and follow-up.
Main Results:
- 73.3% of children receiving vitamin A showed complete resolution of Bitot's spots.
- 13.3% had partial improvement, and 13.3% were unresponsive to vitamin A treatment.
- Nonresponsive children were older, male, and had higher baseline serum vitamin A levels (23.0 µg/dL vs. 15.9 µg/dL).
Conclusions:
- Vitamin A supplementation is effective for most children with Bitot's spots.
- A significant proportion of children with Bitot's spots may have normal vitamin A status.
- The presence of Bitot's spots alone may not always indicate vitamin A deficiency, impacting their utility in prevalence surveys.
Abstract:
In a double-masked, placebo-controlled, clinical trial in Indonesia, 88 preschool children between the ages of 36 and 72 months with Bitot's spots were randomly assigned to 200,000 IU of oral vitamin A or placebo and followed up for five weeks. Baseline and follow-up serum vitamin A levels were obtained. Of the 45 children receiving vitamin A, 33 (73.3%) showed complete cure and disappearance of Bitot's spots, six (13.3%) had disappearance of some but not all Bitot's spots, and six (13.3%) were unresponsive to treatment. The nonresponsive children were older, all male, and had higher initial mean serum vitamin A levels, 23.0 micrograms/dl, compared to 15.9 micrograms/dl in the cured group (P = .017). These data suggest that normal vitamin A status may be found in approximately 13% of children with Bitot's spots before vitamin A intervention and that one fourth of those who had Bitot's spots originally will not be cured of all Bitot's spots after intervention. These are important factors to consider when using Bitot's spots in prevalence surveys as a clinical sign of vitamin A deficiency.