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

Alexandra Howlett; Arne Ohlsson; Nishad Plakkal

doi:10.1002/14651858.CD000366.pub3

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Figure 1

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

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Figure 5

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

Comparison 1 Inositol supplementation versus control, Outcome 8 Sepsis.

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 2.1

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

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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.

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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).

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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).

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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).

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Analysis 2.6

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

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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).

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Analysis 2.8

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

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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]

Comparison 1. Inositol supplementation versus control

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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]

Comparison 2. Inositol supplementation (single dose of 60 mg/kg or 120 mg/kg

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