Selenium supplementation to prevent short-term morbidity in preterm neonates

Higher doses of selenium supplements may be able to reduce some complications for preterm babies, but more research is needed. Selenium is an essential trace element gained from nutrients. Babies are born with lower selenium concentrations in their blood than their mothers. In very preterm babies, low selenium is associated with an increased risk of complications. The review of trials of selenium supplementation for preterm babies found that it reduces sepsis (blood infection). It has not been shown to reduce other complications or increase survival. No adverse effects were reported. Higher than usual levels of selenium supplementation may be beneficial, but more research is needed as most of the evidence comes from a country where selenium levels were unusually low.

Authors' conclusions: 

Supplementing very preterm infants with selenium is associated with benefit in terms of a reduction in one or more episodes of sepsis. Supplementation was not associated with improved survival, a reduction in neonatal chronic lung disease or retinopathy of prematurity. Supplemental doses of selenium for infants on parenteral nutrition higher than those currently recommended may be beneficial. The data are dominated by one large trial from a country with low selenium concentrations and may not be readily translated to other populations.

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Background: 

Selenium is an essential trace element and component of a number of selenoproteins including glutathione peroxidase, which has a role in protecting against oxidative damage. Selenium is also known to play a role in immunocompetence. Blood selenium concentrations in newborns are lower than those of their mothers and lower still in preterm infants. In experimental animals low selenium concentrations appear to increase susceptibility to oxidative lung disease. In very preterm infants low selenium concentrations have been associated with an increased risk of chronic neonatal lung disease and retinopathy of prematurity.

Objectives: 

To assess the benefits and harms of selenium supplementation in preterm or very low birth weight (VLBW) infants.

Search strategy: 

Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), MEDLINE (1966 to May 2003), and Embase (1980 to May 2003). The reference lists of recent trials were also searched and abstracts from the Society for Pediatric Research from 1990 were hand-searched. This search was updated in November, 2010.

Selection criteria: 

Randomised controlled trials which compared selenium supplementation either parenterally or enterally with placebo or nothing from soon after birth in preterm or VLBW infants and which reported clinical outcomes were considered for the review.

Data collection and analysis: 

Data collection and analysis was conducted according to the standards of the Cochrane Neonatal Review Group.

Main results: 

Three eligible trials were identified. Two trials, including one trial with a much larger sample size than the others combined, were from geographical areas with low population selenium concentrations. Meta-analysis of the pooled data showed a significant reduction in the proportion of infants having one or more episodes of sepsis associated with selenium supplementation [summary RR 0.73 (0.57 to 0.93); RD -0.10 (-0.17 to -0.02); NNT 10 (5.9 to 50)]. Supplementation with selenium was not associated with improved survival, a reduction in neonatal chronic lung disease or retinopathy of prematurity.

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