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Review

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

1
Department of Pediatric, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USA
2
Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, Syracuse, NY 13210, USA
3
College of Medicine, University of Kentucky, Lexington, KY 40536, USA
4
Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA
5
Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(3), 791; https://doi.org/10.3390/nu12030791
Received: 10 January 2020 / Revised: 12 March 2020 / Accepted: 16 March 2020 / Published: 17 March 2020
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. View Full-Text
Keywords: Vitamin A; Dextrose; Probiotics; Synbiotics; Low- And Middle-Income Countries; Systematic Review; Neonate; Nutrition Vitamin A; Dextrose; Probiotics; Synbiotics; Low- And Middle-Income Countries; Systematic Review; Neonate; Nutrition
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MDPI and ACS Style

Imdad, A.; Rehman, F.; Davis, E.; Attia, S.; Ranjit, D.; Surin, G.S.; Lawler, S.; Smith, A.; Bhutta, Z.A. 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 2020, 12, 791. https://doi.org/10.3390/nu12030791

AMA Style

Imdad A, Rehman F, Davis E, Attia S, Ranjit D, Surin GS, Lawler S, Smith A, Bhutta ZA. 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. 2020; 12(3):791. https://doi.org/10.3390/nu12030791

Chicago/Turabian Style

Imdad, Aamer, Faseeha Rehman, Evan Davis, Suzanna Attia, Deepika Ranjit, Gamael S. Surin, Sarah Lawler, Abigail Smith, and Zulfiqar A. Bhutta 2020. "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 12, no. 3: 791. https://doi.org/10.3390/nu12030791

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