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.
Highlights
The last two decades have seen a significant decline in rates of childhood mortality the decline in the rate of neonatal mortality has been slower than the decline in mortality beyond the neonatal period [1,2]
We focused on three nutritional interventions i.e. Vitamin A, Dextrose and Probiotics supplementation during the neonatal periods
We included sixteen studies for vitamin A supplementation [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37], thirty three studies in probiotics supplementation and no study was found for dextrose gel supplementation
Summary
The last two decades have seen a significant decline in rates of childhood mortality the decline in the rate of neonatal (age 0–28 days) mortality has been slower than the decline in mortality beyond the neonatal period [1,2]. Optimal nutritional support during the neonatal period is vital to the short- and long-term survival of the newborn [3,4]. The risk of morbidity and mortality during the neonatal period is higher in lowand middle-income countries where many births happen at home and the prevalence of maternal malnutrition and incidence of low birth weight (birth weight less than 2500 g) and preterm birth (gestational age < 37 weeks) is high [3,6,7]. 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.
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