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A recently published article by Dr C
Gopalan of the ‘Nutrition Foundation of
India’ questions the wisdom of the widely accepted
practice of linking Vitamin A administration with
immunisation programmes. In many developing countries,
including India, infants are given 25,000 IU of Vitamin A
at the same time as the three doses of DPT and
polio-vaccine, that is, in the 6th, 10th and 14th week.
In addition to this a further 100,00 IU are given at the
time of measles vaccination.
The article quotes a study which was published in the
Lancet (345:1330 -1332, 1995). The study shows that
vitamin A given with measles vaccination resulted in
substantially lower sero conversion in those infants who
had significant levels of maternally acquired measles
antibody. As nearly two thirds of all infants in the
study did not carry such maternal antibodies, it had to
be concluded that vitamin A administration had impaired
sero conversion. The authors also states that vitamin A
administration could have a similar effect on oral polio
vaccine and other live viral vaccines.
Another side effect of massive vitamin A dose
administration in
early infancy is fontanelle bulging. It was observed that
nearly 12 percent of infants given 50,000 IU in early
infancy developed fontanelle bulging. Later it was shown
that even with a lower dose of Vitamin A (25,000 IU) this
phenomenon was observed.
The author had in an earlier article pointed at the
possible dangerous implications of this finding. He had
stated "One third of infants in South Asia are of
low birth weight to start with and show signs of
psychomotor deficits at birth. Our attempt must be to
help them overcome these initial handicaps. Subjecting
these poor infants to repeated episodes of increased
intracranial tension could contribute to further
retardation of their brain development".Routine Sonography - a
wasted efforts
Ultra sound screening has become a routine for
most pregnant urban Indian women. While the ultrasound is
a useful device the necessity for nearly every pregnant
urban woman to undergo a screening is open to question.
Doctors offer a variety of reasons to defend their
routine use of ultra sound screening during pregnancy. It
is claimed that through such routine screening it is
possible to detect congenital anomalies, multiple
pregnancies, foetal growth disorders, placental
abnormalities and correctly estimate the gestational age.
While all these are potential benefits, what is in
question is the usefullness of a routine test and whether
this leads to a reduction in perinatal mortality and
morbidity.
A study published in the New England Journal of Medicine
in September 1993 (vol. 329, no.12) examines the effect
of such screening on perinatal outcome. The study
involving over 15,000 women, randomly assigned the women
to two groups. One group routinely underwent ultrasound
screening, twice during pregnancy. (First at 15 to 22
weeks and second at 31 to 35 weeks) The women in the
second (Control) group underwent a sonographic
examination only for valid medical reasons identified by
their doctors.
The average number of ultrasound screenings per woman in
the test group and control group was 2.2 and 0.6
respectively. The rate of adverse perinatal outcome was
5.0 percent among infants in the ultrasound screening
group and 4.9 percent in the infants of the control
group. Adverse perinatal outcome was defined as foetal
death, neonatal death or neonatal morbidity. Another
study conducted in an Australian maternity hospital and
published in the New Scientist reported that only
80 to 85 per cent of central nervous disorders and only
25 per cent of heart and circulatory disorders were
diagnosed by ultra sound screening. In this study,
conducted over a three year period, 6137 births were
monitored. Sixty seven babies were born with major
congenital abnormalities and of these, 28 had not been
detected by ultra sound.
If this is the situation in a country where specialised
training and certification is required before one can
practice as an ultra sonologist, one wonders about the
quality of the screening done in India where no such
regulations or requirements exist. On the basis of these
findings it is obvious that routine ultra sound screening
has no role to play in the management of a normal
pregnancy.
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