Reappearance of Bitot's spots after complete resolution in children between 1 and 5 years of age
Umesh Kapil1, Ajeet Singh Bhadoria2, Neha Sareen1
1Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi-110070, India.
Insights
Bitot's spots (BS) in children often reappear even after mega-dose Vitamin A (MDVA) therapy. This study found nearly 62% of children experienced BS recurrence within months, suggesting potential vitamin A sufficiency in some cases.
Area of Science:
- Ophthalmology
- Nutritional Science
- Pediatrics
Background:
- Bitot's spots (BS) are a clinical sign of Vitamin A deficiency.
- Limited data exists on the recurrence rate and resolution patterns of BS after mega-dose Vitamin A (MDVA) administration.
- Understanding these patterns is crucial for managing Vitamin A status in children.
Purpose of the Study:
- To determine the proportion of children with Bitot's spots (BS) that resolve after mega-dose Vitamin A (MDVA) supplementation.
- To investigate the recurrence rate of BS after initial resolution.
- To analyze the time to recurrence of BS following MDVA treatment.
Main Methods:
- A prospective, community-based cohort study was conducted over 12 months in North India.
- Children aged 1-5 years diagnosed with BS received 200,000 IU of Vitamin A on diagnosis, at 4 weeks, and at 6 months.
- Kaplan-Meir analysis was used to determine the median duration of BS reappearance.
Main Results:
- Out of 262 children with BS, 157 (59.9%) showed complete resolution after MDVA supplementation.
- Of those with initial resolution, 97 children (61.8%) experienced a reappearance of BS.
- The median time for BS reappearance after complete resolution was 5 months.
Conclusions:
- Vitamin A mega-dose supplementation leads to BS resolution in a majority of children.
- A significant proportion of children experience recurrence of Bitot's spots even after multiple MDVA doses.
- The reappearance of BS suggests that some children may have adequate serum retinol levels despite presenting with BS, warranting further investigation.
Abstract:
There is limited data on proportion of Bitot's spots (BS), which could reappear after receiving mega dose of Vitamin A (MDVA), and their complete resolution. A prospective, community-based, cohort study with 12 months follow-up was conducted among children (1-5 years) with BS at a district from North India. On diagnosis, 200,000 IU of vitamin A was administered on the same day, then after 4 weeks and subsequently after 6 months. Out of 262 children with BS, 157 (59.9%, 95% CI: 54.1-65.9) children had shown resolution of BS after the MDVA supplementation. Out of 157 children, 97 (61.8%, 95% CI: 54.2-69.4) had reappearance of BS after complete resolution. Kaplan-Meir analysis found that median duration of reappearance of BS was 5 months (95% CI: 3.8-6.2) after their complete resolution. The reappearance of BS after administration of two MDVA within 12 months suggests that children with possibly adequate serum retinol level status may have reappearance of BS.
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