Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis.
Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis.
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DOI：
10.1093/ajcn/nqaa359
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发表时间：
2021-03-11
期刊：
影响因子：
--
通讯作者：
Prendergast AJ
中科院分区：
文献类型：
--
作者：
Noble CCA;Sturgeon JP;Bwakura-Dangarembizi M;Kelly P;Amadi B;Prendergast AJ
严重急性营养不良(SAM)住院儿童出院后长期预后不佳，死亡率、发病率高，神经发育受损。目前，关于如何在住院治疗出院后支持患有SAM的儿童的指导很少。这项系统性综述和荟萃分析旨在研究出院后干预是否能改善复杂SAM康复儿童的预后。对4个数据库进行系统搜索，以确定住院治疗SAM后6-59个月的儿童在出院后完全或部分实施干预措施的研究。人们感兴趣的主要结果是死亡率。在≥2研究在干预和结果方面足够相似的情况下进行随机效应荟萃分析。有10项研究符合纳入标准，在1975至2015年间在7个国家招募了39-1781名参与者。研究评估锌的供应(2项研究)、益生菌或合生菌(2项研究)、抗生素(1项研究)、胰酶(1项研究)和心理社会刺激(4项研究)。有6项研究在≥2结构域上存在不明确或高风险的偏见。与标准护理相比，补充胰酶降低了住院死亡率(37.8%比18.6%，P<0.05)。Meta分析显示益生元或合生元可降低死亡率(RR：0.72；95%CI：0.51，1.00；P=0.049)。心理社会刺激降低了报告死亡的2个试验的荟萃分析中的死亡率(RR：0.36；95%CI：0.15，0.87)，并在所有研究中改善了≥-1领域的神经发育评分。在报告死亡的单一研究中，没有证据表明锌降低了死亡率。抗生素降低了感染发病率，但并没有降低死亡率。一些生物学和心理社会干预措施在改善因SAM住院的儿童预后方面显示出希望，并需要在更大的随机死亡率试验中进一步探索。这项研究已在普罗斯佩罗注册为CRD42018111342(https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).
Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment. This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM. Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6–59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome. Ten studies fulfilled the inclusion criteria, recruiting 39–1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality. Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).
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