Selenium supplementation to prevent short-term morbidity in preterm neonates.

Systematic review of 3 randomized trials in preterm or very low birth weight infants cared for in neonatal units in Australia and New Zealand. The active intervention groups included preterm infants with birthweight thresholds from less than 1000 g to less than 2000 g, with selenium supplementation delivered in neonatal intensive care settings.

Selenium supplementation was given enterally or parenterally as selenious acid, sodium selenate, or sodium selenite. Doses ranged from 1.5 to 7 micrograms/kg/day, usually added to total parenteral nutrition, with one trial switching to oral selenium 5 micrograms/kg/day after feeds were tolerated. Treatment lasted about 18 to 42 days or until 36 weeks postmenstrual age/discharge, compared with placebo, no selenium, or matched control fluid.

Selenium supplementation reduced one or more episodes of sepsis overall, but did not improve survival or reduce chronic lung disease or retinopathy of prematurity. In the largest trial, sepsis after the first week occurred in 67/267 supplemented infants versus 86/258 controls, and no side effects were recorded. Smaller trials were less consistent, with no clear benefit for death, CLD, or ROP.

The evidence base was small and dominated by one large trial, with two much smaller studies contributing limited precision. Doses, routes, and selenium formulations varied across trials, and the findings may not generalize well beyond the enrolled neonatal populations, especially settings with different baseline selenium status.