Blizard Institute, Queen Mary University of London, London, United Kingdom.
Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
Am J Clin Nutr. 2021 Mar 11;113(3):574-585. doi: 10.1093/ajcn/nqaa359.
Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment.
This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM.
Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6-59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome.
Ten studies fulfilled the inclusion criteria, recruiting 39-1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality.
Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).
患有严重急性营养不良 (SAM) 的住院儿童在出院后长期预后较差，死亡率、发病率和神经发育受损率都很高。目前，对于住院治疗后 SAM 儿童的支持，几乎没有指导意见。
本系统评价和荟萃分析旨在研究出院后干预措施是否能改善复杂 SAM 恢复期儿童的结局。
系统检索了 4 个数据库，以确定在住院治疗 SAM 后，6-59 月龄儿童完全或部分出院后干预的研究。主要结局为死亡率。如果 2 项以上研究在干预和结局方面足够相似，则进行随机效应荟萃分析。
10 项研究符合纳入标准，在 1975 年至 2015 年间，在 7 个国家招募了 39-1781 名参与者。研究评估了锌（2 项研究）、益生菌或合生剂（2 项研究）、抗生素（1 项研究）、胰腺酶（1 项研究）和心理社会刺激（4 项研究）的提供情况。6 项研究在 2 个以上领域存在不确定或高偏倚风险。与标准护理相比，胰腺酶补充剂降低了住院死亡率（37.8%比 18.6%，P<0.05）。荟萃分析结果表明，合生剂或合生剂在一定程度上降低了死亡率（RR：0.72；95%CI：0.51，1.00；P=0.049）。在报告死亡的 2 项试验的荟萃分析中，心理社会刺激降低了死亡率（RR：0.36；95%CI：0.15，0.87），并改善了所有研究中至少 1 个领域的神经发育评分。在唯一报告死亡的研究中，锌并未降低死亡率。抗生素降低了传染性发病率，但并未降低死亡率。
一些生物和心理社会干预措施在改善 SAM 住院儿童的结局方面显示出希望，需要在更大规模的死亡率随机试验中进一步探索。本研究在 PROSPERO 注册为 CRD42018111342（https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342）。
