Selenium supplementation to prevent short-term morbidity in preterm neonates

Area of Science:

• Neonatal Medicine
• Nutritional Science
• Pediatric Critical Care

Background:

• Selenium is an essential trace element vital for selenoproteins like glutathione peroxidase, crucial for antioxidant defense and immune function.
• Newborns, particularly preterm infants, have lower blood selenium levels, increasing susceptibility to oxidative stress and certain morbidities.
• Low selenium has been linked to increased risks of chronic neonatal lung disease and retinopathy of prematurity in very preterm infants.

Purpose of the Study:

• To evaluate the efficacy and safety of selenium supplementation in preterm or very low birthweight infants.
• To assess the impact of selenium on key clinical outcomes including mortality, sepsis, and respiratory and visual complications.

Main Methods:

• Systematic review of randomized controlled trials identified through comprehensive database searches (Cochrane CENTRAL, MEDLINE, Embase) and hand-searched abstracts.
• Included trials compared selenium supplementation (parenteral or enteral) against placebo or no supplementation in preterm/very low birthweight infants, reporting clinical outcomes.
• Data extraction focused on dosage, route, mortality, oxygen requirements, sepsis, chronic lung disease, and retinopathy of prematurity; blood selenium and glutathione peroxidase levels were also analyzed.

Main Results:

• Meta-analysis of three eligible trials, dominated by a large study from a low-selenium region, revealed a significant reduction in sepsis episodes with selenium supplementation (NNT 10).
• Selenium supplementation did not demonstrate a significant benefit in improving survival rates.
• No significant reduction was observed in the incidence of neonatal chronic lung disease or retinopathy of prematurity.

Conclusions:

• Selenium supplementation in very preterm infants is associated with a reduced incidence of sepsis.
• Current evidence does not support selenium supplementation for improved survival, reduced chronic lung disease, or prevention of retinopathy of prematurity.
• Higher supplemental selenium doses, particularly for infants receiving parenteral nutrition, may warrant further investigation, acknowledging the limitations of data from low-selenium populations.