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肠内补充维生素A预防早产儿支气管肺发育不良:一项更新的系统评价和荟萃分析。

Enteral vitamin a supplementation for the prevention of bronchopulmonary dysplasia in preterm infants: an updated systematic review and meta-analysis.

作者信息

Rustam Aamenah, Gill Muhammad Arshman, Shafique Hajrah, Safdar Muhammad Abdul Rehman, Khan Bilal Yasin, Haseeb Abdul, Ali Mubariz, Razwan Muhammad, Ahmed Umair, Raza Hassan, Qureshi Ali Akram, Ehsan Muhammad, Awan Rehmat Ullah, Munasar Asmaa

机构信息

Women Medical College, Abbottabad, Pakistan.

Services institute of medical sciences, Lahore, Pakistan.

出版信息

Ann Med Surg (Lond). 2025 May 30;87(8):5132-5141. doi: 10.1097/MS9.0000000000003452. eCollection 2025 Aug.


DOI:10.1097/MS9.0000000000003452
PMID:40787545
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12333754/
Abstract

MATERIAL AND METHODS: We searched several databases using Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. We included only placebo-controlled clinical trials on infants born at less than 32 weeks' gestation, who were administered enteral vitamin A supplementation. A random effects model was employed to calculate risk ratios and weighted mean differences. RESULTS: A total of five studies with 1715 participants were included in our meta-analysis. No significant reduction was observed in the incidence of moderate-to-severe bronchopulmonary dysplasia [RR = 0.91, 95% CI (0.70, 1.17), = 0.45], retinopathy of prematurity requiring treatment [RR = 0.94, 95% CI (0.62 to 1.42), = 0.76], sepsis [RR = 0.96 95% CI (0.74 to 1.24), = 0.73], mortality RR = 0.86, 95% CI, (0.65 to 1.15), = 0.31], and duration of mechanical ventilation [MD = -0.93 days 95% CI (-2.90 to 1.04) = 0.36] between the vitamin A and control group. Among the secondary outcomes, only the duration of CPAP/HFNC (days) showed statistically significant results [MD = -1.29, 95%CI (-1.93, -0.66), < 0.0001]. Meanwhile, there was no statistically significant difference between the experimental and placebo groups with regards to duration of hospitalization, duration of minimally invasive ventilation and oxygen, requirement for postnatal steroids, serum retinol concentration at 28 days, necrotizing enterocolitis, periventricular leukomalacia, intraventricular hemorrhage and vomiting. CONCLUSION: Supplementing premature infants with enteral vitamin A might shorten the duration of noninvasive respiratory support requirement. However, there is a lack of evidence for its superior efficacy in improving the overall health outcomes for premature infants compared to placebo.

摘要

材料与方法:我们使用Cochrane对照试验中央注册库、MEDLINE、Embase和ClinicalTrials.gov检索了多个数据库。我们仅纳入了对孕周小于32周的婴儿进行肠内补充维生素A的安慰剂对照临床试验。采用随机效应模型计算风险比和加权平均差。 结果:我们的荟萃分析共纳入了5项研究,1715名参与者。维生素A组和对照组在中重度支气管肺发育不良的发生率[风险比=0.91,95%置信区间(0.70,1.17),P=0.45]、需要治疗的早产儿视网膜病变[风险比=0.94,95%置信区间(0.62至1.42),P=0.76]、败血症[风险比=0.96,95%置信区间(0.74至1.24),P=0.73]、死亡率[风险比=0.86,95%置信区间(0.65至1.15),P=0.31]以及机械通气时间[平均差=-0.93天,95%置信区间(-2.90至1.04),P=0.36]方面均未观察到显著降低。在次要结局中,只有持续气道正压通气/高流量鼻导管吸氧时间(天)显示出统计学显著结果[平均差=-1.29,95%置信区间(-1.93,-0.66),P<0.0001]。同时,试验组和安慰剂组在住院时间、微创通气和吸氧时间、产后使用类固醇的需求、28天时的血清视黄醇浓度、坏死性小肠结肠炎、脑室周围白质软化、脑室内出血和呕吐方面没有统计学显著差异。 结论:对早产儿进行肠内补充维生素A可能会缩短无创呼吸支持的需求时间。然而,与安慰剂相比,缺乏证据表明其在改善早产儿总体健康结局方面具有更优疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/c25b2ec93f43/ms9-87-5132-g007.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/f93481ed5d92/ms9-87-5132-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/3a94818d8559/ms9-87-5132-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/c25b2ec93f43/ms9-87-5132-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/4f76796a9e77/ms9-87-5132-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/53282493159a/ms9-87-5132-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/251878977086/ms9-87-5132-g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/f93481ed5d92/ms9-87-5132-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/3a94818d8559/ms9-87-5132-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cda/12333754/c25b2ec93f43/ms9-87-5132-g007.jpg

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[1]
Enteral vitamin a supplementation for the prevention of bronchopulmonary dysplasia in preterm infants: an updated systematic review and meta-analysis.

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本文引用的文献

[1]
AI model using clinical images for genomic prediction and tailored treatment in patients with cancer.

Lancet Oncol. 2025-3

[2]
Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries.

Neonatology. 2025

[3]
Artificial intelligence alphafold model for molecular biology and drug discovery: a machine-learning-driven informatics investigation.

Mol Cancer. 2024-10-5

[4]
Complications of Preterm Birth-The Importance of Care for the Outcome: A Narrative Review.

Medicina (Kaunas). 2024-6-20

[5]
Early postnatal high-dose fat-soluble enteral vitamin A supplementation for moderate or severe bronchopulmonary dysplasia or death in extremely low birthweight infants (NeoVitaA): a multicentre, randomised, parallel-group, double-blind, placebo-controlled, investigator-initiated phase 3 trial.

Lancet Respir Med. 2024-7

[6]
Postnatal weight gain and retinopathy of prematurity in preterm infants: a population-based retrospective cohort study.

J Matern Fetal Neonatal Med. 2024-12

[7]
An exploratory study of clinical factors associated with IGF-1 and IGFBP-3 in preterm infants.

Pediatr Res. 2024-7

[8]
National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis.

Lancet. 2023-10-7

[9]
Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Campbell Syst Rev. 2021-3-5

[10]
Predictors of Bronchopulmonary Dysplasia in Infants With Birth Weight Less Than 1500 g.

Glob Pediatr Health. 2023-2-2

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