title: Selenium Supplementation for Prevention of Late-Onset Sepsis in Very Low Birth Weight Preterm Neonates.
abstract: BACKGROUND
  Neonatal mortality continues to be a significant problem in the Indian setting, especially in very low birth weight (VLBW) neonates. Selenium (Se) has been shown to possess antioxidant properties, and some recent studies have shown a reduction in the sepsis-attributable neonatal mortality with its use. India is a Se-deficient country. Blood Se concentrations in newborns are lower than those of their mothers and lower still in preterm infants.
  
  
  OBJECTIVE
  To evaluate the efficacy of Se in preventing the first episode of late-onset sepsis in VLBW preterm neonates.
  
  
  METHODS
  Ninety neonates weighing <1500 g and period of gestation <32 weeks, asymptomatic at birth and admitted to the neonatal intensive-care unit (NICU) in the first 12 h of birth with no maternal risk factors for sepsis were analyzed in the study. Se or placebo was supplemented orally once daily from 1st to 28th day of life to the test (n = 45) or control (n = 45) groups, respectively, followed by daily clinical assessment for signs or symptoms of sepsis in the hospital and weekly after discharge.
  
  
  RESULTS
  Preterm VLBW neonates (mean birth weight 1464.22 ± 50.14 g and mean gestational age 221.75 ± 4 days) are Se deficient at birth, with mean (SD) Se levels 31.1 ± 14.8 µg/l. Se supplementation at 10 µg/day increased serum Se levels significantly (63.9 ± 13.9 µg/l on Day 28 in Se vs. 40.9 ± 17.3 on Day 28 in placebo; p < 0.01). The incidence of the first episode of culture-proven late-onset sepsis was significantly lower in the Se than in the placebo group. [0/45 (0%) in Se vs. 6/45 (13.3%) in placebo; p = 0.033]. The incidence of probable sepsis was found to be significantly lower in the Se group [7/45 (15.55%)] than in the placebo [16/45 (35.55%)]; p = 0.02. The total incidence of any late-onset sepsis (i.e. culture-proven plus probable sepsis) was also significantly reduced by Se supplementation. [7/45 (15.55%) in Se vs. 22/45 (48.88%) in placebo; p = 0.001].
  
  
  CONCLUSIONS
  Preterm VLBW neonates are Se deficient at birth. Se supplementation at 10 µg/day resulted in getting the Se levels into the acceptable normal level and reduced the incidence of the first episode of late-onset sepsis in these neonates.
authors: Pt. B.D.S. Post-Graduate Institute of Medical Sciences, Rohtak, India geetagathwala@gmail.com.
authors: Rahul
authors: R
authors: Aggarwal
authors: Pt. B.D.S. Post-Graduate Institute of Medical Sciences, Rohtak, India.
authors: Geeta
authors: G
authors: Gathwala
authors: Jawaharlal Nehru University, New Delhi, India.
authors: Sudesh
authors: S
authors: Yadav
authors: Jawaharlal Nehru University, New Delhi, India.
authors: Pawan
authors: P
authors: Kumar
mesh_terms: D017668:Age of Onset; D000975:Antioxidants / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D012643:Selenium / Q000008:administration & dosage* / Q000097:blood / Q000172:deficiency*; D018805:Sepsis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D012643:Selenium
keywords: VLBW preterm neonates; late-onset sepsis; selenium