Department of Nutrition in Public Health, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Fundamental Nutrition-Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Nutr Rev. 2022 Oct 10;80(11):2136-2153. doi: 10.1093/nutrit/nuac028.
Nutritional interventions for newborns with brain injury are scarce, and there are gaps in the knowledge of their mechanisms of action in preventing the occurrence of cerebral palsy (CP) or the incidence of other developmental disabilities.
The objective of this review was to assess the effect of nutritional interventions in preventing nonprogressive congenital or perinatal brain injuries, or in improving outcomes related to neurological development.
Randomized trials on any nutritional intervention for pregnant women at risk of preterm delivery, or for children with low birth weight, preterm, or with confirmed or suspected microcephaly, CP, or fetal alcohol syndrome disorders (FASDs) were retrieved from MEDLINE, Embase, Scopus, Web of Science, LILACS, and CENTRAL databases from inception to September 17, 2020.
Data extraction, risk of bias (Cochrane Risk of Bias tool 2), and quality of evidence (GRADE approach) were assessed by 2 authors.
Pooled risk ratios (RRs) with 95% confidence intervals were calculated using a random-effects meta-analysis. Seventeen studies were included on intravenous interventions (magnesium sulfate [n = 5], amino acids [n = 4], vitamin A [n = 1], and N-acetylcysteine [n = 1]); enteral interventions (vitamin D [n = 1], prebiotic [n = 1], nutrient-enriched formula [n = 1], and speed of increasing milk feeds [n = 1]); and oral interventions (choline [n = 1] and docosahexaenoic acid, choline, and uridine monophosphate [n = 1]). All studies assessed CP, except 1 on FASDs. Eight studies were judged as having high risk of bias. Five studies (7413 babies) with high-quality evidence demonstrated decreased risk of childhood CP (RR = 0.68, 95% CI: 0.52-0.88) with magnesium sulfate. Interventions with amino acids had no effect on CP prevention or other outcomes. Except for 1 study, no other intervention decreased the risk of CP or FASDs.
Although different types of nutritional interventions were found, only those with antenatal magnesium sulfate were effective in decreasing CP risk in preterm infants. Well-designed, adequately powered randomized clinical trials are required.
针对脑损伤新生儿的营养干预措施很少，其预防脑瘫（CP）或其他发育障碍发生的作用机制的相关知识也存在空白。
本综述旨在评估营养干预措施预防非进行性先天性或围产期脑损伤，或改善与神经发育相关结局的效果。
从 MEDLINE、Embase、Scopus、Web of Science、LILACS 和 CENTRAL 数据库中检索了针对有早产风险的孕妇或低出生体重、早产或确诊或疑似小头畸形、CP 或胎儿酒精谱系障碍（FASD）患儿的任何营养干预的随机试验，检索时间截至 2020 年 9 月 17 日。
两名作者分别进行数据提取、偏倚风险评估（Cochrane 偏倚风险工具 2）和证据质量评估（GRADE 方法）。
使用随机效应荟萃分析计算汇总风险比（RR）及其 95%置信区间。纳入了 17 项研究，涉及静脉内干预（硫酸镁 [n=5]、氨基酸 [n=4]、维生素 A [n=1]和 N-乙酰半胱氨酸 [n=1]）、肠内干预（维生素 D [n=1]、益生元 [n=1]、营养强化配方 [n=1]和增加奶量速度 [n=1]）和口服干预（胆碱 [n=1]和二十二碳六烯酸、胆碱和尿苷单磷酸 [n=1]）。除了 1 项关于 FASD 的研究外，所有研究均评估了 CP。8 项研究被判断为高偏倚风险。5 项研究（7413 名婴儿，高质量证据）表明，硫酸镁可降低儿童 CP 的风险（RR=0.68，95%CI：0.52-0.88）。氨基酸干预对 CP 预防或其他结局没有影响。除了 1 项研究外，没有其他干预措施降低 CP 或 FASD 的风险。
尽管发现了不同类型的营养干预措施，但只有产前硫酸镁具有降低早产儿 CP 风险的作用。需要进行设计良好、充分有力的随机临床试验。
