{'fraction_non_alphanumeric': 0.044332915098285235, 'fraction_numerical': 0.020911752404851526, 'mean_word_length': 4.763855421686747, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Efficacy of enteral zinc supplementation for neonatal sepsis

We read with great interest the meta-analysis of Tang et al. [1] on the efficacy of zinc supplementation for neonatal sepsis published in the Journal of Maternal-Fetal & Neonatal Medicine. The authors reported that enteral zinc supplementation significantly reduced mortality in neonatal sepsis, with a risk ratio (RR) of 0.48 (95% confidence interval [CI] 0.25–0.94). Unfortunately, we detected several problems in the review that seriously affect the validity of the authors’ conclusions. The authors included four randomized controlled trials (RCTs) [2–5] in their systematic review. However, they did not realize that three of the four included studies reported on the same overlapping population [3–5]. That these three studies refer to the same population is acknowledged by Banupriya et al. in the most recent of the three publications [5]. When encountering multiple reports of the same underlying RCT, it is crucial to only include the RCT once in the meta-analysis, to avoid duplication of results [6]. If the meta-analysis is repeated including only the RCT of Mehta et al. [2], and the version of the RCT of Banupriya et al. with the highest number of patients [5], the results change substantially. As shown in Figure 1, meta-analysis does not find that zinc supplementation significantly affects mortality (RR 0.749, 95% CI 0.238–2.354, p1⁄4 .621), and we found substantial heterogeneity between the two studies (I1⁄4 77.7%). We were also surprised that the authors reported a meta-analysis on the outcome “mortality” and another one on the outcome “number of expired patients” [1]. We have reviewed the original articles, and we cannot find a difference between the definitions of these outcomes. Tang et al. do not clarify this distinction in their review. In addition, the other outcomes in the meta-analysis are also affected by the duplication of the RCTs of Banupriya et al. [3–5]. Staub et al. recently published a Cochrane protocol [7] aimed at reviewing the effects of enteral zinc supplementation in neonatal morbidity and mortality. However, the results of the systematic review are not yet available. We hope that this review clarifies the possible efficacy of zinc supplementation in neonatal sepsis. In the meantime, the conclusions of the meta-analysis of Tang et al. [1] are unfortunately not valid.