Updated Meta-analysis of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Neonates
Updated Meta-analysis of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Neonates
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DOI：
10.1542/peds.2009-1301
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发表时间：
2010-05-01
期刊：
影响因子：
8
通讯作者：
Bulsara, Max
中科院分区：
文献类型：
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作者：
Deshpande, Girish;Rao, Shripada;Bulsara, Max
目的：随机对照试验（RCT）的系统评价表明，早产（< 34周妊娠）极低出生体重（VLBW;出生体重< 1500 g）新生儿补充益生菌后，死亡率和坏死性小肠结肠炎（NEC）较低，至完全喂养的时间较短。本研究的目的是更新我们的2007年系统评价的随机对照试验的益生菌补充预防NEC早产VLBW news.METHODS：我们在2009年3月检索了科克伦中心注册; Medline，Embase和Cinahl数据库;和儿科学术学会会议和胃肠病学会议的会议记录。遵循科克伦新生儿审查组检索策略。选择标准为任何肠内益生菌补充剂的RCT，在早产VLBW新生儿中开始于前10天内并持续>= 7天，并报告2期NEC或更高（改良Bell分期）。结果：共有11项（N = 2176），包括4项新试验（N = 783），通过使用固定效应模型，试验符合纳入荟萃分析的条件。NEC和死亡的风险显著降低。败血症的风险没有显著差异。未报告显著不良反应。试验序贯分析）显示NEC的发病率降低30%（α = 0.05和0.01;功效：80%）。结论：结果证实了益生菌补充剂在减少早产儿死亡和疾病方面的显著益处。显著的效应量、严格的置信区间、极低的P值和总体证据表明，如果有合适的益生菌产品，则无需进行额外的安慰剂对照试验。儿科2010;125：921-930
OBJECTIVE: Systematic reviews of randomized, controlled trials (RCTs) indicate lower mortality and necrotizing enterocolitis (NEC) and shorter time to full feeds after probiotic supplementation in preterm (< 34 weeks' gestation) very low birth weight (VLBW; birth weight < 1500 g) neonates. The objective of this study was to update our 2007 systematic review of RCTs of probiotic supplementation for preventing NEC in preterm VLBW neonates.METHODS: We searched in March 2009 the Cochrane Central register; Medline, Embase, and Cinahl databases; and proceedings of the Pediatric Academic Society meetings and gastroenterology conferences. Cochrane Neonatal Review Group search strategy was followed. Selection criteria were RCTs of any enteral probiotic supplementation that started within first 10 days and continued for >= 7 days in preterm VLBW neonates and reported on stage 2 NEC or higher (Modified Bell Staging).RESULTS: A total of 11 (N = 2176), including 4 new (n = 783), trials were eligible for inclusion in the meta-analysis by using a fixed-effects model. The risk for NEC and death was significantly lower. Risk for sepsis did not differ significantly. No significant adverse effects were reported. Trial sequential analysis) showed 30% reduction in the incidence of NEC (alpha =.05 and.01; power: 80%).CONCLUSIONS: The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The dramatic effect sizes, tight confidence intervals, extremely low P values, and overall evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available. Pediatrics 2010;125:921-930