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Meta-Analysis
. 2020 Mar 17;12(3):791.
doi: 10.3390/nu12030791.

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

Aamer Imdad  1 , Faseeha Rehman  1 , Evan Davis  2 , Suzanna Attia  3 , Deepika Ranjit  2 , Gamael Saint Surin  2 , Sarah Lawler  4 , Abigail Smith  4 , Zulfiqar A Bhutta  5
Affiliations
Meta-Analysis

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

Aamer Imdad et al. Nutrients. .

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords: Dextrose; Low- And Middle-Income Countries; Neonate; Nutrition; Probiotics; Synbiotics; Systematic Review; Vitamin A.

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Conflict of interest statement

Dr. Bhutta was involved as principle investigator in one of the included study. He did not participate in screening or data extraction for this study. Rest of the authors declare no conflict of interest. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow Diagram.
Figure 2
Figure 2
Effect of neonatal vitamin A supplementation on all-cause mortality at 6 months from studies conducted in the community settings from low- and middle-income countries.
Figure 3
Figure 3
Effect of neonatal probiotic supplementation on all-cause mortality.
Figure 4
Figure 4
Effect of neonatal probiotic supplementation on incidence of Necrotizing Enterocolitis.
See this image and copyright information in PMC

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