Vitamin A for non-measles pneumonia in children

 

Abstract

Background

Acute respiratory infections, mostly in the form of pneumonia, are the leading causes of death in children under five years of age in low-income countries. Some clinical trials have demonstrated that vitamin A supplementation reduces the severity of respiratory infections and mortality in children with measles.

Objectives

To determine whether adjunctive vitamin A is effective in children diagnosed with non-measles pneumonia.

Search methods

We searched The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL 2010, issue 3) which contains the Acute Respiratory Infections Group's Specialised Regsiter, MEDLINE (1996 to July week 3, 2010), EMBASE (1990 to August 2010), LILACS (1985 to August 2010), CINAHL (1990 to August 2010), Biological Abstracts (1990 to August 2010), Current Contents (1990 to August 2010) and the Chinese Biomedicine Database (CBM) (1994 to June 2010).

Selection criteria

Only parallel-arm, randomized controlled trials (RCTs) and quasi-RCTs, in which children (younger than 15 years of age) with non-measles pneumonia were treated with adjunctive vitamin A, were included.

Data collection and analysis

Two review authors independently extracted data and assessed trial quality. Study authors were contacted for additional information.

Main results

Six trials involving 1740 children were included. There was no significant reduction in mortality associated with pneumonia in children treated with vitamin A compared to those who were not (pooled odds ratio (OR) 1.29; 95% confidence interval (CI) 0.63 to 2.66). Also, there was no statistically significant difference in duration of hospital stay (mean difference (MD) 0.08; 95% CI -0.43 to 0.59). Disease severity after supplementary high-dose vitamin A was significantly worse compared with placebo. However, low-dose vitamin A significantly reduced the recurrence rate of bronchopneumonia (OR 0.12; 95% CI 0.03 to 0.46). Moderate vitamin A significantly reduced the time to remission of signs in children with normal serum retinol (> 200 ug/L).

Authors' conclusions

The evidence does not suggest a significant reduction in mortality, measures of morbidity, nor an effect on the clinical course of pneumonia with vitamin A adjunctive treatment in children with non-measles pneumonia. However, not all studies measured all outcomes, which limited 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.

 

Plain language summary

Vitamin A for non-measles pneumonia in children

Acute respiratory infections, mostly in the form of pneumonia, are the leading cause of death in children under five years of age living in low-income countries. Vitamin A supplementation has been found to reduce mortality and the severity of respiratory infections in children with measles. This updated review was undertaken to assess the effectiveness of vitamin A adjunctive therapy in children with non-measles respiratory infections, particularly pneumonia.

We found six trials (1740 participants) that used vitamin A adjunctive therapy in children with non-measles pneumonia. There was no significant reduction in mortality or duration of hospital stay. Supplementary high-dose vitamin A may result in a worsening of the disease, and low-dose vitamin A significantly reduces the recurrence of bronchopneumonia. Moderate-dose vitamin A significantly reduces the time to remission of signs in children with normal serum retinol. The possible reason of the lack of benefit of vitamin A in non-measles pneumonia is that the effects of vitamin A may be disease-specific, with vitamin A only being effective when pneumonia is complicated with measles. Further high-quality research is required.

 

摘要

背景

維生素A用於非麻疹引起肺炎的兒童

在低收入國家中5歲以下的兒童之主要死亡原因為急性呼吸道感染，其中以肺炎為主要表現形式。一些臨床試驗証明，補充維生素A可以降低兒童因麻疹引起呼吸道感染的嚴重度及死亡率。

目標

要確定維生素A之補充對於非麻疹引起肺炎的兒童是否有效。

搜尋策略

我們資料搜尋包括考科藍註冊中心之對照試驗(簡稱CENTRAL)(考科藍圖書館 2007年第3期); MEDLINE檢索(1996年至2007年8月第2週);醫學文摘庫(1990年至2007年1月);LILACS資料庫(2007年5月6日); CINAHL資料庫(1990年至2007年8月)，生物學文摘(1990年至2007年7月);當前目錄(1990年至2007年5月)及中國生物醫學數據庫(1994年至2007年6月)。

選擇標準

所有被收錄之研究必須為對等比較，隨機和半隨機對照試驗(RCT)，實驗對象為未滿15歲之兒童並以維生素A補充之非麻疹引起之肺炎。

資料收集與分析

由兩名作者獨立擷取資料並評估臨床實驗報告之可信度。並與這些研究的作者聯繫已取得更多的資料。

主要結論

總共6個試驗，共1740名兒童被收錄。相較於沒有接受維生素A治療的兒童，接受維生素A治療的肺炎感染之兒童在死亡率沒有顯著之降低(合併或然率(OR)1.29; 95％信賴區間(CI)0.62至2.69)。此外，住院時間長短也無統計學上差異，(平均差異(MD)0.08; 95％信賴區間為 −0.43至0.59)。補充維生素A可以降低39％第一線抗生素治療失敗的機率(或然率0.65，95％信賴區間為 0.42至1.01)。給予高劑量維生素A相較於安慰劑組對疾病的嚴重程度有顯著惡化。然而，低劑量維生素A補充對於支氣管肺炎之復發率有顯著之降低(或然率0.12，95％信賴區間為 0.03至0.46)。與血清視黃醇正常之兒童(> 200微克/升)相比，以中劑量維生素A補充之兒童顯著縮短復原的時間。

作者結論

對於非麻疹引起肺炎的兒童以維生素A補充，目前沒有證據顯示可以顯著降低死亡率，發病率，或肺炎治療的效果。然而，並非所有研究都有測量結果，因此鮮少數的研究可以被納入進行薈萃分析，或許因此而無法得到統計學上的差異。

翻譯人

本摘要由臺灣大學附設醫院林敬凱翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

維生素A用於非麻疹引起肺炎的兒童。 在低收入國家中5歲以下的兒童之主要死亡原因為急性呼吸道感染，其中以肺炎為主要表現形式。補充維生素A可以降低兒童因麻疹引起呼吸道感染的嚴重度及死亡率。此篇文獻回顧，是在評估維生素A輔助性治療對兒童非因麻疹引起之呼吸道感染，特別是肺炎的療效。我們發現目前幾乎沒有證據的顯示補充維生素A對於治療兒童因非麻疹引起之肺炎有幫助。