Supplementary Material for: Supportive care for common conditions in small vulnerable newborns and term infants: the evidence

Introduction Small vulnerable newborns (SVN) are at an increased risk of early death and other morbidities. Essential interventions provided to SVN, and other high-risk newborns have been proven critical in improving their outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).
Method Following a comprehensive literature scope, we updated or re-analyzed LMIC-specific evidence for essential SVN care interventions.
Results A total of 113 individual LMIC studies were identified. Most of them were of high risk of bias. Kangaroo mother care (KMC) significantly reduced SVN’s mortality by discharge. Early erythropoiesis stimulating agent lowered SVN’s risk of receiving blood transfusion. Prophylactic oral or intravenous ibuprofen resulted in a decreased risk of patent ductus arteriosus in SVN. But it did not have a significant effect on mortality and led to a higher risk of gastrointestinal bleeding. No pooled LMIC data were available for universal screening of hyperbilirubinemia in high-risk newborns. Sunlight therapy had no effect in treating hyperbilirubinemia but increased the risk of hyperthermia. Reflective curtains with phototherapy resulted in a greater and faster decline in bilirubin than standard phototherapy in treating hyperbilirubinemia. Early child development (ECD) interventions were shown to have a favorable effect on cognitive and motor scores in SVN. The evidence for family involvement and family support was limited and uncertain.
Conclusion We present the most updated LMIC evidence for interventions targeting SVN. Despite their effectiveness and safety in improving certain neonatal outcomes, further high-quality trials are required.

引言：脆弱高危新生儿（Small Vulnerable Newborns，SVN）早期死亡及其他并发症的风险显著升高。针对脆弱高危新生儿及其他高危新生儿的核心干预措施已被证实对改善其临床结局至关重要。本研究旨在更新此类干预措施在低收入和中等收入国家（Low- and Middle-Income Countries，LMICs）中的有效性与安全性相关证据。
方法：本研究通过全面的文献范围梳理，针对脆弱高危新生儿的核心照护干预措施，更新或重新分析了低收入和中等收入国家（LMICs）的专属研究证据。
结果：本研究共纳入113项独立的低收入和中等收入国家相关研究，其中大部分存在较高的偏倚风险。袋鼠式护理（Kangaroo Mother Care，KMC）可显著降低脆弱高危新生儿至出院时的死亡率。早期促红细胞生成素制剂可降低脆弱高危新生儿接受输血的风险。预防性口服或静脉注射布洛芬可降低脆弱高危新生儿动脉导管未闭的发生风险，但该措施对死亡率无显著影响，且会增加胃肠道出血的风险。目前尚无针对高危新生儿高胆红素血症普遍筛查的低收入和中等收入国家汇总数据。日光疗法对高胆红素血症无治疗效果，但会增加体温过高的风险。与标准光疗相比，搭配反光窗帘的光疗可使高胆红素血症患儿的胆红素水平下降幅度更大、速度更快。儿童早期发展（Early Child Development，ECD）干预措施可对脆弱高危新生儿的认知与运动评分产生积极影响。关于家庭参与与家庭支持的相关证据较为有限且结论尚不明确。
结论：本研究提供了目前最新的针对脆弱高危新生儿干预措施的低收入和中等收入国家相关证据。尽管此类干预措施在改善部分新生儿临床结局方面具备有效性与安全性，但仍需开展更多高质量临床试验。