BULGING FONTANELLE AFTER SUPPLEMENTATION WITH 25000 IU OF VITAMIN-A IN INFANCY USING IMMUNIZATION CONTACTS

To evaluate the safety of vitamin A supplementation in early infancy u sing DPT/OPV immunization contracts, a double-blind, randomized, place bo-controlled trial was conducted in Bangladesh. One hundred and sixty -seven infants received three doses of either 25 000 IU of vitamin A o r a placebo at about 6.5, 11.8 and 17.0 weeks of age. Trained physicia ns examined each of the infants on days 1, 2, 3 and 8 after supplement ation. Nine infants (2.5%) supplemented with vitamin A had episodes of bulging of the fontanelle compared with two infants (2.5%) in the pla cebo group (p < 0.05). Twelve of the 14 episodes occurred in infants s upplemented with vitamin A of these 12 episodes, none occurred with th e first dose, 3 occurred with the second and 9 with the third dose. Th e higher incidence of bulging of the fontanelle in the vitamin A group relative to the placebo group and its temporal association with the v itamin A doses are suggestive of a causal association. The finding tha t increased numbers of vitamin A doses were associated with a higher p robability of bulging of the fontanelle suggests a cumulative effect.