The Beneficial Anti-inflammatory and Anti-oxidative Effects of Selenium Supplementation in Critically Ill Post-surgical Pediatric Patients

Document Type: Review Article


1 Department of Nutrition,Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Oxidative stress after major surgeries is associated with the development of poor clinical outcomes including delayed wound healing and increase in Pediatric Intensive Care Unit (PICU) length of stay. Due to the growth and development phase in childhood, the change in the levels of oxidative stress and inflammation is of high importance in these patients. Notably, the acute metabolic stress which is in association with oxidative stress rate, is believed to increase after major surgeries in pediatric patients. It is suggested that the presence of selenium in different selenoenzymes and selenoproteins, may play a major role in anti-oxidative defense system in surgical inflammation through regulation of glycolysis, gluconeogenesis, insulin transport pathways and gene expression of inflammatory mediators and other functions of lymphocytes B and T, natural killer and lymphokine activated killer cells. Selenium requirement in acute metabolic stress following major surgeries is essential for pediatric cases, therefore selenium supplementation in such patients may be helpful and cost effective in long term. Further clinical studies are required to clarify the potential beneficial effects of selenium supplementation in addition to its dose safety and efficacy rate.


1.             Broman M, Lindfors M, Norberg A, Hebert C, Rooyackers O, Wernerman J, et al. Low serum selenium is associated with the severity of organ failure in critically ill children. Clinical Nutrition (Edinburgh, Scotland). 2018; 37(4): 1399-405.

2.             Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017; 36(3): 623-50.

3.             Abad-Jorge A. Nutrition Management of the Critically Ill Pediatric Patient: Minimizing Barriers to Optimal Nutrition Support. Infant Child Adolesc Nutr. 2013; 5(4): 221-30.

4.             Hardy G, Hardy I, Manzanares W. Selenium supplementation in the critically ill. Nutr Clin Pract. 2012; 27(1): 21-33.

5.             Leite HP, Nogueira PC, Iglesias SB, de Oliveira SV, Sarni RO. Increased plasma selenium is associated with better outcomes in children with systemic inflammation. Nutrition. 2015; 31(3): 485-90.

6.             Roman M, Jitaru P, Barbante C. Selenium biochemistry and its role for human health. Metallomics. 2014; 6(1): 25-54.

7.             Burjonrappa SC, Miller M. Role of trace elements in parenteral nutrition support of the surgical neonate. J Pediatr Surg. 2012; 47(4): 760-71.

8.             National Research Council (US) Subcommittee on Selenium. Selenium in Nutrition: Revised Edition. Washington (DC): National Academies Press (US); 1983. 7, Effects of Excess Selenium. Available from:

9.             Combs GF Jr. Biomarkers of selenium status. Nutrients. 2015; 7(4): 2209-36.

10. Papp LV, Lu J, Holmgren A, Khanna KK. From selenium to selenoproteins: synthesis, identity, and their role in human health. Antioxid Redox Signal. 2007; 9(7): 775-806.

11. Leite HP, Nogueira PC, Iglesias SB, de Oliveira SV, Sarni RO. Increased plasma selenium is associated with better outcomes in children with systemic inflammation. Nutrition. 2015; 31(3): 485-90.

12. Niskar AS, Paschal DC, Kieszak SM, Flegal KM, Bowman B, Gunter EW, et al. Serum selenium levels in the US population: Third National Health and Nutrition Examination Survey, 1988-1994. Biol Trace Elem Res. 2003; 91(1): 1-10.

13. Safaralizadeh R, Kardar GA, Pourpak Z, Moin M, Zare A, Teimourian S. Serum concentration of selenium in healthy individuals living in Tehran. Nutr J. 2005; 4: 32.

14. Smajic J, Tupkovic LR, Husic S, Avdagic SS, Hodzic S, Imamovic S. Systemic Inflammatory Response Syndrome in Surgical Patients. Med Arch. 2018; 72(2): 116-9.

15. Aviello G, Knaus UG. ROS in gastrointestinal inflammation: Rescue Or Sabotage? Br J Pharmacol. 2017; 174(12): 1704-18.

16. Stoppe C, Schalte G, Rossaint R, Coburn M, Graf B, Spillner J, et al. The intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients. Crit Care Med. 2011; 39(8): 1879-85.

17. McHoney M, Eaton S, Pierro A. Metabolic Response to Surgery in Infants and Children. Eur J Pediatr Surg. 2009; 19(5): 275-85.

18. Duntas LH. Selenium and inflammation: underlying anti-inflammatory mechanisms. Horm Metab Res. 2009; 41(6): 443-7.

19. Manzanares W, Lemieux M, Elke G, Langlois PL, Bloos F, Heyland DK. High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care. 2016; 20(1): 356.

20. de Oliveira Iglesias SB, Leite HP, Paes A, de Oliveira SV, Sarni RO. Low plasma selenium concentrations in critically ill children: the interaction effect between inflammation and selenium deficiency. Crit Care. 2014; 18(3): R101.

21. de Oliveira Ulbrecht MO, Goncalves DA, Zanoni LZG, do Nascimento VA. Association Between Selenium and Malondialdehyde as an Efficient Biomarker of Oxidative Stress in Infantile Cardiac Surgery. Biol Trace Elem Res. 2019; 187(1): 74-9.

22. Osland EJ, Ali A, Isenring E, Ball P, Davis M, Gillanders L. Australasian Society for Parenteral and Enteral Nutrition guidelines for supplementation of trace elements during parenteral nutrition. Asia Pac J Clin Nutr. 2014; 23(4): 545-54.