Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries
<i>Background:</i> 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 supplem...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-03-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/12/3/791 |
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| author | Aamer Imdad Faseeha Rehman Evan Davis Suzanna Attia Deepika Ranjit Gamael Saint Surin Sarah Lawler Abigail Smith Zulfiqar A. Bhutta |
| author_facet | Aamer Imdad Faseeha Rehman Evan Davis Suzanna Attia Deepika Ranjit Gamael Saint Surin Sarah Lawler Abigail Smith Zulfiqar A. Bhutta |
| author_sort | Aamer Imdad |
| collection | DOAJ |
| description | <i>Background:</i> 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. <i>Methods:</i> 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. <i>Results:</i> 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. <i>Conclusions:</i> 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. |
| first_indexed | 2024-04-13T15:16:49Z |
| format | Article |
| id | doaj.art-7a0465c787b6494baaac8de96b70a253 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-04-13T15:16:49Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-7a0465c787b6494baaac8de96b70a2532022-12-22T02:41:51ZengMDPI AGNutrients2072-66432020-03-0112379110.3390/nu12030791nu12030791Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income CountriesAamer Imdad0Faseeha Rehman1Evan Davis2Suzanna Attia3Deepika Ranjit4Gamael Saint Surin5Sarah Lawler6Abigail Smith7Zulfiqar A. Bhutta8Department of Pediatric, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USADepartment of Pediatric, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USADepartment of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, Syracuse, NY 13210, USACollege of Medicine, University of Kentucky, Lexington, KY 40536, USADepartment of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, Syracuse, NY 13210, USADepartment of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, Syracuse, NY 13210, USAHealth Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USAHealth Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USACentre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada<i>Background:</i> 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. <i>Methods:</i> 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. <i>Results:</i> 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. <i>Conclusions:</i> 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.https://www.mdpi.com/2072-6643/12/3/791vitamin adextroseprobioticssynbioticslow- and middle-income countriessystematic reviewneonatenutrition |
| spellingShingle | Aamer Imdad Faseeha Rehman Evan Davis Suzanna Attia Deepika Ranjit Gamael Saint Surin Sarah Lawler Abigail Smith Zulfiqar A. Bhutta Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries Nutrients vitamin a dextrose probiotics synbiotics low- and middle-income countries systematic review neonate nutrition |
| title | Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries |
| title_full | Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries |
| title_fullStr | Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries |
| title_full_unstemmed | Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries |
| title_short | Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries |
| title_sort | effect of synthetic vitamin a and probiotics supplementation for prevention of morbidity and mortality during the neonatal period a systematic review and meta analysis of studies from low and middle income countries |
| topic | vitamin a dextrose probiotics synbiotics low- and middle-income countries systematic review neonate nutrition |
| url | https://www.mdpi.com/2072-6643/12/3/791 |
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