Introduction: Severe COVID-19 in pregnancy is strongly associated with preterm infant late-onset sepsis (LOS), which is a major cause of morbidity and mortality in infants. Recently, Lactoferrin, an iron-binding protein significantly discovered in human colostrum, shows potential effect on reducing the risk of preterm infant LOS and mortality by its immunomodulatory properties. Therefore, this study aimed to evaluate the effect of Lactoferrin on reducing the risk of preterm LOS, necrotizing enterocolitis (NEC), and mortality in preterm infants. Methods: This study followed the guidelines provided by PRISMA. A literature search was conducted with PubMed, Cochrane Library, Google Scholar, and ScienceDirect. The combined effect of LOS, NEC and mortality incidence were presented as risk ratios (RR) with a 95% confidence interval (CI) using a random-effects model (REM) or fixed-effects model (FEM) forest plot. Furthermore, the heterogeneity level was checked by I2 and the p-value of the chi2 test. Results: The incidence of LOS was significantly higher in the control than lactoferrin supplementation group [RR=0.65, 95% CI (0.56,0.77), p<0.00001, I2=56%]. However, there were no significant differences in NEC [RR=0.80, 95% CI (0.63,1.02), p=0.10, I2=39%] and mortality [RR=0.94, 95% CI (0.77,1.13), p=0.49, I2=39%], despite the trends are higher in the control group. Conclusion: This meta-analysis showed that enteral lactoferrin supplementation in preterm infants was associated with a significant reduction in LOS, but not NEC stage II or III and all-cause mortality. Registered Protocol: The protocol of this review was already registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021279189.
<p class="AbstractNormal"><strong>Pendahuluan: </strong>Gagal hati kronis eksaserbasi akut merupakan dekompensasi penyakit hati kronis yang sering berkaitan dengan infeksi virus hepatitis B (HBV). Terapi <em>Mesenchymal stem cells </em>(MSCs) telah menunjukkan hasil yang menjanjikan untuk meningkatkan fungsi hati secara in vivo. Kajian ini bertujuan untuk menilai potensi MSCs pada pasien dengan gagal hati kronis eksaserbasi akut terkait infeksi HBV.</p><p class="AbstractNormal"><strong>Metode:</strong><strong> </strong>Meta-analisis ini dibuat berdasarkan pedoman PRISMA. Pencarian literatur dilakukan dengan beberapa <em>database</em> elektronik, yakni PubMed, ScienceDirect, PMC, Google Scholar, dan Cochrane Library. <em>Risk ratio</em> (RR) dan <em>standardized mean difference</em> (SMD) dengan standar deviasi (SD) digunakan untuk membandingkan risiko mortalitas, skor <em>model for end-stage liver disease</em> (MELD), dan total bilirubin (TBIL) dari pemberian MSCs dan <em>standard medical therapy </em>(SMT).</p><p class="AbstractNormal"><strong>Hasil:</strong><strong> </strong>Kajian ini menunjukkan bahwa risiko mortalitas cenderung lebih tinggi pada kelompok SMT (pooled RR= 0.52, 95%CI (0.40,0,69), p<0.00001, <em>I<sup>2</sup>=</em>0%). Skor MELD juga cenderung lebih tinggi pada kelompok SMT sampai 12 bulan setelah pengobatan (pooled SMD 0.36, 95%CI (0.07, 0.65), p= 0.00002, <em>I<sup>2</sup>=</em>65%). Perubahan TBIL lebih besar pada kelompok MSCs sampai dengan 4 minggu (pooled SMD= 0.20, 95%CI (-0.11,0.52), p=0.3, <em>I<sup>2</sup></em>=16%) dan perubahan TBIL secara keseluruhan sampai 12 bulan menunjukkan adanya perbedaan antara intervensi MSCs dan SMT (pooled SMD= -0.07, 95%CI (-0.23,0.08), p=0.05, <em>I<sup>2</sup>= </em>42%).</p><strong>Kesimpulan: </strong>Kajian ini memberikan bukti kuat yang menunjukkan terapi MSCs memiliki potensi yang bermanfaat untuk meningkatkan fungsi hati pada pasien dengan gagal hati kronis eksaserbasi akut terkait infeksi HBV.
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