Supplementing preterm babies who have respiratory distress with the nutrient inositol may reduce death and disability

Howlett A, Ohlsson A, Plakkal N

Published Online:

March 14, 2012

Inositol is an essential nutrient for cells, with high concentrations in breast milk (particularly in the breast milk of mothers whose babies have been born early). A drop in inositol levels in babies with respiratory distress syndrome (RDS) can be a sign that their illness will be a severe one. The review found that the initial evidence regarding inositol supplementation in preterm babies with RDS is promising. Supplementation lowered rates of death, bleeding in the brain, and with an important reduction in eye problems as well. Inositol did not have serious adverse effects. Further research is warranted to confirm these preliminary findings. Such research is currently ongoing in the USA.

Abstract (click to read)

Background:

Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life.

Objectives:

To assess the effectiveness/safety of supplementary inositol in preterm infants with respiratory distress syndrome (RDS) in reducing adverse neonatal outcomes.

Search strategy:

The Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, Clinicaltrials.gov and Controlled-trials.com were searched in May, 2011. The reference lists of identified randomized controlled trials (RCTs), personal files and Web of Science were searched.

Selection criteria:

All RCTs of inositol supplementation to preterm infants with a control group that received a placebo or no intervention were included. Outcomes of interest were neonatal death, infant death, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and sepsis.

Data collection and analysis:

Data on neonatal outcomes were abstracted independently by the three review authors and any discrepancy was resolved through consensus. Outcomes were reported as relative risk (RR), risk difference (RD) and number needed to treat to benefit (NNT).

Main results:

Four published and one ongoing randomized controlled trials were identified. Study quality varied and interim analyses had occurred in all trial that provided data for the outcomes. Neonatal death was found to be significantly reduced [three trials, 355 neonates, typical RR 0.53 (95% CI 0.31 to 0.91); RD -0.09 (95% CI -0.17 to -0.03); NNT 11 (95% CI 6 to 33). Infant deaths were reduced [three trials, 355 infants, typical RR 0.55 (95% CI 0.40 to 0.77); RD -0.18 (95% CI -0.27 to -0.08); NNT 6 (95% CI 4 to 13). ROP, stage ≥ 3 was significantly reduced [two trials, 262 infants, typical RR 0.09 (95% CI 0.01 to 0.67); typical RD -0.08 (95% CI -0.13 to -0.03); NNT 13 (95% CI 8 to 33)]. IVH grade > II was significantly decreased [three trials, 355 infants typical RR 0.53 (95% CI 0.31 to 0.90; typical RD -0.09 (95% CI -0.16 to -0.02); NNT 11 (95% CI 6 to 50). Neither sepsis nor NEC differed significantly between groups. One ongoing pharmacokinetics study of inositol in preterm infants was identified.

Authors' conclusions:

Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A multicenter randomized controlled trial of appropriate size is justified to confirm these findings.

This record should be cited as:

Howlett A, Ohlsson A, Plakkal N. Inositol for respiratory distress syndrome in preterm infants. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD000366. DOI: 10.1002/14651858.CD000366.pub2

Assessed as up to date:

November 1, 2011

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Respiratory distress syndrome > Other interventions

Complementary & alternative medicine > Neonatal care > Respiratory distress syndrome

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Supplementing preterm babies who have respiratory distress with the nutrient inositol may reduce death and disability

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