Department of Pediatric, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, Syracuse, NY 13210, USA.
Nutrients. 2020 Mar 17;12(3):791. doi: 10.3390/nu12030791.
Suboptimal nutritional status of a newborn is a risk factor for short- and long-term morbidity and mortality. The objectives of this review were to assess the efficacy and effectiveness of neonatal synthetic vitamin A supplementation, dextrose gel and probiotic supplementation for prevention of morbidity and mortality during infancy in low and middle-income countries. We included randomized trials. Primary outcome was all-cause mortality. We conducted electronic searches on multiple databases. Data were meta-analyzed to obtain relative risk (RR) and 95% confidence interval (CI). Studies for vitamin A and Probiotics were analyzed separately. No studies were found for dextrose gel supplementation during neonatal period. The overall rating of evidence was determined by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Sixteen studies assessed the effect of vitamin A supplementation during the neonatal period. Based on pooled data from community-based studies only, there was no significant effect of vitamin A on all-cause mortality at age 1 month (RR 0.99, 95% CI 0.90, 1.08), 6 months (RR 0.98; 95% CI 0.89-1.08) and 12 months (RR 1.04, 95% CI 0.94, 1.14) but increased risk of bulging fontanelle (RR 1.53, 95% CI 1.12, 2.09). The overall quality of evidence was high for the above outcomes. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period and were mostly conducted in the hospital setting. Probiotics reduced the risk of all-cause mortality (RR 0.80, 95% CI 0.66, 0.96), necrotizing enterocolitis (RR 0.46, 95% CI 0.35, 0.59) and neonatal sepsis (RR 0.78, 95% CI 0.70, 0.86). The grade ratings for the above three outcomes were high. Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in low and middle-income countries in the community setting. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born low birth weight and/or preterm in the hospital setting.
新生儿营养状况不佳是短期和长期发病率和死亡率的一个风险因素。本综述的目的是评估在中低收入国家，新生儿合成维生素 A 补充、葡萄糖凝胶和益生菌补充剂对预防婴儿期发病和死亡的疗效和效果。我们纳入了随机试验。主要结局是全因死亡率。我们在多个数据库上进行了电子检索。对数据进行了荟萃分析，以获得相对风险（RR）和 95%置信区间（CI）。对维生素 A 和益生菌的研究进行了单独分析。在新生儿期没有发现葡萄糖凝胶补充的研究。证据的总体评价由推荐评估、制定和评估（GRADE）方法确定。16 项研究评估了新生儿期补充维生素 A 的效果。仅基于基于社区的研究的汇总数据，维生素 A 对 1 个月（RR 0.99，95%CI 0.90，1.08）、6 个月（RR 0.98；95%CI 0.89-1.08）和 12 个月（RR 1.04，95%CI 0.94，1.14）时的全因死亡率没有显著影响，但增加了前囟隆起的风险（RR 1.53，95%CI 1.12，2.09）。上述结果的总体证据质量很高。33 项研究评估了新生儿期补充益生菌的效果，这些研究主要在医院进行。益生菌降低了全因死亡率（RR 0.80，95%CI 0.66，0.96）、坏死性小肠结肠炎（RR 0.46，95%CI 0.35，0.59）和新生儿败血症（RR 0.78，95%CI 0.70，0.86）的风险。上述三个结果的等级评价均为高。新生儿期补充维生素 A 并不能降低中低收入国家社区环境中新生儿或婴儿的全因死亡率。新生儿期补充益生菌似乎可以降低低出生体重和/或早产儿在医院环境中全因死亡率、NEC 和败血症的发生。
