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Makanan pelengkap dengan Vitamin E untuk mencegah penyakit dan kematian di kalangan bayi pramatang

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Abstract

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Background

Treating very low birth weight (VLBW) infants with pharmacologic doses of vitamin E as an antioxidant agent has been proposed for preventing or limiting retinopathy of prematurity, intracranial hemorrhage, hemolytic anemia, and chronic lung disease. However, excessive doses of vitamin E may result in concerning side effects.

Objectives

To assess the effects of vitamin E supplementation on morbidity and mortality in preterm infants.

Search methods

MEDLINE (October 2002), EMBASE (March 2002), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2003), and personal files for clinical trials assessing vitamin E in preterm infants were searched. The MEDLINE and CCTR searches were updated in March 2007.

Selection criteria

Trials analyzing primary outcomes (mortality or combined long‐term morbidity) or secondary outcomes (other morbidity) in infants with gestational age less than 37 weeks or birth weight less than 2500 grams were selected. The intervention was allocation to routine supplementation with vitamin E in the treatment group versus placebo, no treatment or another type, dose or route of administration of vitamin E.

Data collection and analysis

The standard methods of the Cochrane Collaboration and of the Cochrane Neonatal Review Group were used.

Main results

Twenty‐six randomized clinical trials fulfilled entry criteria. No study assessed combined long‐term morbidity. Routine vitamin E supplementation significantly increased hemoglobin concentration by a small amount. Vitamin E significantly reduced the risk of germinal matrix/intraventricular hemorrhage and increased the risk of sepsis; however, heterogeneity limits the strength of these latter two inferences. Vitamin E did not significantly affect other morbidity or mortality. In VLBW infants, vitamin E supplementation significantly increased the risk of sepsis, and reduced the risk of severe retinopathy and blindness among those examined.
Subgroup analyses demonstrated (1) an association between intravenous, high‐dose vitamin E supplementation and increased risk of sepsis and of parenchymal cerebral hemorrhage; (2) an association between vitamin E supplementation by other than the intravenous route and reduced risk of germinal matrix‐intraventricular hemorrhage and of severe intraventricular hemorrhage; and (3) an association between serum tocopherol levels greater than 3.5 mg/dl and increased risk of sepsis and reduced risk for severe retinopathy among those examined.

Authors' conclusions

Vitamin E supplementation in preterm infants reduced the risk of intracranial hemorrhage but increased the risk of sepsis. In very low birth weight infants, vitamin E increased the risk of sepsis, and reduced the risk of severe retinopathy and blindness among those examined. Evidence does not support the routine use of vitamin E supplementation by intravenous route at high doses or aiming at serum tocopherol levels greater than 3.5 mg/dl.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Ringkasan bahasa mudah

Makanan pelengkap dengan Vitamin E untuk mencegah penyakit dan kematian di kalangan bayi pramatang

Pemberian tambahan vitamin E kepada bayi pramatang boleh mendatangkan beberapa manfaat, tetapi ia menambahkan risiko jangkitan yang menggugat nyawa. Bayi pramatang (dilahirkan sebelum 37 minggu) boleh mendapat beberapa masalah kerana organ‐organ mereka belum matang, Vitamin E mungkin dapat bantu mencegahkan atau menghadkan beberapa masalah ini, tetapi ia berpotensi menimbulkan kesan‐kesan yang bahaya. Susu dari wanita yang telah melahirkan bayi pramatang mengandungi paras Vitamin E yang lebih tinggi dari lazimnya. Bayi pramatang boleh diberikan tambahan vitamin E secara titisan vitamin, susu formula yang diperkayakan dengan vitamin E, cecair intravena, atau melalui suntikan otot. Ulasan kajian‐kajian makanan pelengkap dengan vitamin E mendapati bahawa tambahan vitamin E mengurangkan peluang mendapat komplikasi (termasuk penyakit pada retina mata) tetapi risiko jangkitan yang menggugat nyawa meningkat. Risiko perdarahan dalam otak meningkat apabila tambahan vitamin E diberikan melalui vena tetapi menurun apabila tambahan vitamin E diberikan melalui kaedah lain.