Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis

被引:45
作者
Araki, Shunsuke [1 ]
Kato, Shin [2 ]
Namba, Fumihiko [3 ]
Ota, Erika [4 ]
机构
[1] Univ Occupat & Environm Hlth, Sch Med, Dept Pediat, Kitakyushu, Fukuoka, Japan
[2] Nagoya City Univ, Grad Sch Med Sci, Dept Pediat & Neonatol, Mizuho Ku, Nagoya, Aichi, Japan
[3] Saitama Med Univ, Saitama Med Ctr, Dept Pediat, Kawagoe, Saitama, Japan
[4] St Lukes Int Univ, Grad Sch Nursing Sci, Global Hlth Nursing, Chuo Ku, Tokyo, Japan
关键词
LUNG-DISEASE; SUPPLEMENTATION; TRIAL; DEATH; RISK;
D O I
10.1371/journal.pone.0207730
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Vitamin A (VA) supplementation reduces the risk of developing bronchopulmonary dysplasia (BPD). However, a previous meta-analysis showed that VA had minimal efficacy for preventing BPD in very low birth weight infants (VLBWIs). Aims To elucidate the effects of VA supplementation for BPD prevention in extremely low birth weight infants (ELBWIs). Study design This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We registered the protocol on PROSPERO, the international prospective registry of systematic reviews (registration number: CRD42016050887). We searched the following five databases: CINAHL, CENTRAL, EMBASE, MEDLINE, and PubMed; screened the reference lists of retrieved articles to identify randomized controlled trials (RCTs); and assessed the Cochrane Risk of Bias for each study. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results Four studies (total, 1,011 infants) were included. VA was administered intramuscularly in 3 studies and orally in 1 study. VA supplementation for ELBWIs had benefited oxygen dependency at the postmenstrual age of 36 weeks in survivors (pooled risk ratio, 0.88; 95% confidence intervals (CI), 0.77-0.99; 4 trials, 841 infants, moderate certainty of evidence), which is similar to the meta-analysis in VLBWIs. Length of hospital stay was reduced in the VA group (mean difference, -49.9; 95% CI, -88.78 to -11.02; 1 trial, 20 infants, low certainty of evidence). The meta-analysis showed no reduction in the risk of neonatal death, oxygen use at 28 days in survivors, duration of mechanical ventilation, intraventricular hemorrhage, retinopathy in prematurity, and necrotizing enterocolitis. Conclusions VA supplementation for ELBWIs is potentially effective in decreasing oxygen dependency at the postmenstrual age of 36 weeks.
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