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Información

DOI:
https://doi.org/10.1002/14651858.CD000366.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 04 febrero 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Alexandra Howlett

    Correspondencia a: Section of Neonatology, Alberta Children's Hospital, Calgary, Canada

    [email protected]

    Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Canada

  • Arne Ohlsson

    Departments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

  • Nishad Plakkal

    Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry, Puducherry, India

Contributions of authors

All review authors contributed to all stages of this update of the review in 2014.

Sources of support

Internal sources

  • Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada.

  • Mount Sinai Hospital, Toronto, Ontario, Canada.

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA.

    The Cochrane Neonatal Review Group has been funded in part with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN267200603418C

Declarations of interest

Dr Alexandra Howlett ‐ none.

Dr Arne Ohlsson ‐ none.

Dr Nishad Plakkal ‐ none.

Acknowledgements

We are thankful to Dr Friedman who provided us with additional unpublished information related to the abstract publication. We are grateful to Dr Phelps who drew our attention to her ongoing study in 2007. For this update we obtained clarifying information regarding the Phelps 2012NCT01954082; Phelps 2013 and NCT01954082 studies.

The editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN267200603418C.

Version history

Published

Title

Stage

Authors

Version

2019 Jul 08

Inositol in preterm infants at risk for or having respiratory distress syndrome

Review

Alexandra Howlett, Arne Ohlsson, Nishad Plakkal

https://doi.org/10.1002/14651858.CD000366.pub4

2015 Feb 04

Inositol in preterm infants at risk for or having respiratory distress syndrome

Review

Alexandra Howlett, Arne Ohlsson, Nishad Plakkal

https://doi.org/10.1002/14651858.CD000366.pub3

2012 Mar 14

Inositol for respiratory distress syndrome in preterm infants

Review

Alexandra Howlett, Arne Ohlsson, Nishad Plakkal

https://doi.org/10.1002/14651858.CD000366.pub2

2003 Oct 20

Inositol for respiratory distress syndrome in preterm infants

Review

Alexandra Howlett, Arne Ohlsson

https://doi.org/10.1002/14651858.CD000366

Differences between protocol and review

For the original review and previous updates of the review the main comparison has been 'inositol supplementation versus control' (Comparison 1) and we included studies under this comparison that provided repeated doses of inositol to the infants. For this update we identified one dose‐finding study in which infants were supplemented with a single dose of inositol (Phelps 2013). We did not consider it appropriate to include the results of this study in the meta‐analyses of repeated doses of inositol and we have changed the first comparison to read: 'inositol supplementation (repeat doses) versus control' (Comparison 1) and added a second comparison that reads 'inositol supplementation (single dose) versus control' (Comparison 2). These different dosing regimens were not known at the protocol stage and we have made a deviation from the protocol and included single doses of inositol in our review as those analyses provide important information. The infants in the study by Phelps 2013 were not included based on whether they had respiratory distress syndrome or not. To justify inclusion of this study we changed the title of the review to 'Inositol in preterm infants at risk for or having respiratory distress syndrome'. For this update we changed the objectives to read: to assess the effectiveness and safety of supplementary inositol in preterm infants with or without respiratory distress syndrome (RDS) in reducing adverse neonatal outcomes. Outcomes were not reported in an identical manner in the repeat doses of inositol studies and the single dose of inositol study (Phelps 2013). We accepted the outcomes and their definitions reported in the Phelps 2013 study.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.1 Neonatal death (age < 28 days).
Figuras y tablas -
Figure 1

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.1 Neonatal death (age < 28 days).

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.2 Infant death (age < one year).
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.2 Infant death (age < one year).

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.5 Retinopathy of prematurity, stage ≥ 3.
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.5 Retinopathy of prematurity, stage ≥ 3.

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.6 Retinopathy of prematurity, any stage.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.6 Retinopathy of prematurity, any stage.

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.9 Intraventricular haemorrhage, grade > 2.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Inositol supplementation versus control, outcome: 1.9 Intraventricular haemorrhage, grade > 2.

Comparison 1 Inositol supplementation versus control, Outcome 1 Neonatal death (age < 28 days).
Figuras y tablas -
Analysis 1.1

Comparison 1 Inositol supplementation versus control, Outcome 1 Neonatal death (age < 28 days).

Comparison 1 Inositol supplementation versus control, Outcome 2 Infant death (age < one year).
Figuras y tablas -
Analysis 1.2

Comparison 1 Inositol supplementation versus control, Outcome 2 Infant death (age < one year).

Comparison 1 Inositol supplementation versus control, Outcome 3 Bronchopulmonary dysplasia (at 28 to 30 days of age).
Figuras y tablas -
Analysis 1.3

Comparison 1 Inositol supplementation versus control, Outcome 3 Bronchopulmonary dysplasia (at 28 to 30 days of age).

Comparison 1 Inositol supplementation versus control, Outcome 4 Bronchopulmonary dysplasia (at 36 to 38 weeks PMA).
Figuras y tablas -
Analysis 1.4

Comparison 1 Inositol supplementation versus control, Outcome 4 Bronchopulmonary dysplasia (at 36 to 38 weeks PMA).

Comparison 1 Inositol supplementation versus control, Outcome 5 Retinopathy of prematurity, stage ≥ 3.
Figuras y tablas -
Analysis 1.5

Comparison 1 Inositol supplementation versus control, Outcome 5 Retinopathy of prematurity, stage ≥ 3.

Comparison 1 Inositol supplementation versus control, Outcome 6 Retinopathy of prematurity, any stage.
Figuras y tablas -
Analysis 1.6

Comparison 1 Inositol supplementation versus control, Outcome 6 Retinopathy of prematurity, any stage.

Comparison 1 Inositol supplementation versus control, Outcome 7 Necrotizing enterocolitis.
Figuras y tablas -
Analysis 1.7

Comparison 1 Inositol supplementation versus control, Outcome 7 Necrotizing enterocolitis.

Comparison 1 Inositol supplementation versus control, Outcome 8 Sepsis.
Figuras y tablas -
Analysis 1.8

Comparison 1 Inositol supplementation versus control, Outcome 8 Sepsis.

Comparison 1 Inositol supplementation versus control, Outcome 9 Intraventricular haemorrhage, grade > 2.
Figuras y tablas -
Analysis 1.9

Comparison 1 Inositol supplementation versus control, Outcome 9 Intraventricular haemorrhage, grade > 2.

Comparison 1 Inositol supplementation versus control, Outcome 10 Intraventricular haemorrhage, all grades.
Figuras y tablas -
Analysis 1.10

Comparison 1 Inositol supplementation versus control, Outcome 10 Intraventricular haemorrhage, all grades.

Comparison 1 Inositol supplementation versus control, Outcome 11 Minor neural developmental impairment at one year corrected age.
Figuras y tablas -
Analysis 1.11

Comparison 1 Inositol supplementation versus control, Outcome 11 Minor neural developmental impairment at one year corrected age.

Comparison 1 Inositol supplementation versus control, Outcome 12 Major neural developmental impairment at one year corrected age.
Figuras y tablas -
Analysis 1.12

Comparison 1 Inositol supplementation versus control, Outcome 12 Major neural developmental impairment at one year corrected age.

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 1 Death during hospital stay.
Figuras y tablas -
Analysis 2.1

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 1 Death during hospital stay.

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 2 Bronchopulmonary dysplasia at 36 weeks PMA.
Figuras y tablas -
Analysis 2.2

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 2 Bronchopulmonary dysplasia at 36 weeks PMA.

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 3 Retinopathy of prematurity (infants who underwent surgery for ROP).
Figuras y tablas -
Analysis 2.3

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 3 Retinopathy of prematurity (infants who underwent surgery for ROP).

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 4 Necrotizing enterocolitis (stage 2A or worse).
Figuras y tablas -
Analysis 2.4

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 4 Necrotizing enterocolitis (stage 2A or worse).

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 5 Necrotizing enterocolitis (infants who underwent surgery for NEC).
Figuras y tablas -
Analysis 2.5

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 5 Necrotizing enterocolitis (infants who underwent surgery for NEC).

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 6 Sepsis (late onset).
Figuras y tablas -
Analysis 2.6

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 6 Sepsis (late onset).

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 7 Intraventricular haemorrhage (grade 3 or 4).
Figuras y tablas -
Analysis 2.7

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 7 Intraventricular haemorrhage (grade 3 or 4).

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 8 Hearing test (failed both ears).
Figuras y tablas -
Analysis 2.8

Comparison 2 Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg, Outcome 8 Hearing test (failed both ears).

Comparison 1. Inositol supplementation versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Neonatal death (age < 28 days) Show forest plot

3

355

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.31, 0.91]

2 Infant death (age < one year) Show forest plot

3

355

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.40, 0.77]

3 Bronchopulmonary dysplasia (at 28 to 30 days of age) Show forest plot

3

343

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.54, 1.13]

4 Bronchopulmonary dysplasia (at 36 to 38 weeks PMA) Show forest plot

1

177

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.64, 2.64]

5 Retinopathy of prematurity, stage ≥ 3 Show forest plot

2

262

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.01, 0.67]

6 Retinopathy of prematurity, any stage Show forest plot

3

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.38, 1.01]

7 Necrotizing enterocolitis Show forest plot

3

355

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.51, 2.70]

8 Sepsis Show forest plot

2

307

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.51, 1.37]

9 Intraventricular haemorrhage, grade > 2 Show forest plot

3

355

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.31, 0.90]

10 Intraventricular haemorrhage, all grades Show forest plot

2

307

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.61, 1.11]

11 Minor neural developmental impairment at one year corrected age Show forest plot

1

169

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.38, 1.86]

12 Major neural developmental impairment at one year corrected age Show forest plot

1

169

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.24, 1.16]

Figuras y tablas -
Comparison 1. Inositol supplementation versus control
Comparison 2. Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death during hospital stay Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.34, 4.21]

2 Bronchopulmonary dysplasia at 36 weeks PMA Show forest plot

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.74 [0.88, 8.48]

3 Retinopathy of prematurity (infants who underwent surgery for ROP) Show forest plot

1

25

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.10, 1.22]

4 Necrotizing enterocolitis (stage 2A or worse) Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.12, 1.39]

5 Necrotizing enterocolitis (infants who underwent surgery for NEC) Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.08, 3.41]

6 Sepsis (late onset) Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

1.46 [0.71, 2.97]

7 Intraventricular haemorrhage (grade 3 or 4) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.29, 3.90]

8 Hearing test (failed both ears) Show forest plot

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.09, 3.84]

Figuras y tablas -
Comparison 2. Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg