Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials.
Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants: A Systematic Review and Network Meta-analysis of Randomized Trials.
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益生菌降低了早产，低出生体重婴儿的死亡率和发病率：对随机试验的系统评价和网络荟萃分析。
DOI：
10.1053/j.gastro.2020.05.096
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发表时间：
2020-08
期刊：
影响因子：
29.4
通讯作者：
McMaster Probiotic, Prebiotic, and Synbiotic Work Group
中科院分区：
文献类型：
--
作者：
Morgan RL;Preidis GA;Kashyap PC;Weizman AV;Sadeghirad B;McMaster Probiotic, Prebiotic, and Synbiotic Work Group
我们的目的是在随机试验的网络荟萃分析中比较单菌株益生菌和多菌株益生菌的有效性。我们检索了截至2019年1月1日的MEDLINE、Embase、科学引文索引扩展、CINAHL、Scope us、Cochrane Central、BIOSIS Previews和Google Scholar，以寻找单菌株和多菌株益生菌制剂对早产儿、低出生体重新生儿结局的研究。我们使用频数法进行网络荟萃分析，并使用推荐评估、发展和评价(等级)方法来评估证据的确定性。主要结果包括全因死亡率、严重坏死性小肠结肠炎(NEC)(Bell II期或以上)和培养证实的败血症。我们分析了涉及15,712名早产儿的63项试验的数据。与安慰剂相比，一种或多种乳杆菌(SPP)和一种或多种双歧杆菌的组合是唯一具有降低全因死亡率的中等或高质量证据的干预措施(优势比[OR]，0.56；95%可信区间[CI]，0.39-0.80)。在与安慰剂相比具有中等或高质量疗效证据的干预措施中，一种或多种乳杆菌和一种或多种双歧杆菌、动物双歧杆菌、雷氏乳杆菌或鼠李糖乳杆菌的组合显著减少了严重的NEC(OR，0.35[95%CI，0.20-0.59]；OR，0.31[95%CI，0.13-0.74]；OR，0.55[95%CI，0.34-0.91]；以及OR，0.44[95%CI，0.21-0.90])。有中等或高质量的证据表明，1个或更多乳杆菌和1个或更多双歧杆菌和布拉酵母的组合减少了达到完全喂养的天数(平均减少3.30天[95%可信区间，减少5.91-0.69天])。有中等或高质量的证据表明，与安慰剂相比，单品种产品B亚乳酸乙酯或L可显著缩短住院时间(平均缩短13.00d[95%可信区间，缩短22.71~3.29d]和平均缩短7.89d[95%可信区间，缩短11.60~4.17d])。在一项研究的系统综述和网络荟萃分析中，我们发现1个或多个乳杆菌和1个或多个双歧杆菌组合相对于单菌株和其他多菌株益生菌治疗方案具有优越性，这些研究旨在确定单菌和多菌制剂对早产儿、低出生体重新生儿结局的影响。芽孢杆菌和肠球菌，以及一种或多种双歧杆菌和唾液链球菌嗜热亚种的组合可能对NEC的发展产生最大的抑制作用。还需要进一步的试验。
We aimed to compare the effectiveness of single- vs multiple-strain probiotics in a network meta-analysis of randomized trials. We searched MEDLINE, Embase, Science Citation Index Expanded, CINAHL, Scopus, Cochrane CENTRAL, BIOSIS Previews, and Google Scholar through January 1, 2019, for studies of single-strain and multistrain probiotic formulations on the outcomes of preterm, low-birth-weight neonates. We used a frequentist approach for network meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Primary outcomes included all-cause mortality, severe necrotizing enterocolitis (NEC) (Bell stage II or more), and culture-proven sepsis. We analyzed data from 63 trials involving 15,712 preterm infants. Compared with placebo, a combination of 1 or more Lactobacillus species (spp) and 1 or more Bifidobacterium spp was the only intervention with moderate- or high-quality evidence of reduced all-cause mortality (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39–0.80). Among interventions with moderate- or high-quality evidence for efficacy compared with placebo, combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp, Bifidobacterium animalis subspecies lactis, Lactobacillus reuteri, or Lactobacillus rhamnosus significantly reduced severe NEC (OR, 0.35 [95% CI, 0.20–0.59]; OR, 0.31 [95% CI, 0.13–0.74]; OR, 0.55 [95% CI, 0.34–0.91]; and OR, 0.44 [95% CI, 0.21–0.90], respectively). There was moderate- or high-quality evidence that combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp and Saccharomyces boulardii reduced the number of days to reach full feeding (mean reduction of 3.30 days [95% CI, reduction of 5.91–0.69 days]). There was moderate- or high-quality evidence that, compared with placebo, the single-species product B animalis subsp lactis or L reuteri significantly reduced duration of hospitalization (mean reduction of 13.00 days [95% CI, reduction of 22.71–3.29 days] and mean reduction of 7.89 days [95% CI, reduction of 11.60–4.17 days], respectively). In a systematic review and network meta-analysis of studies to determine the effects of single-strain and multistrain probiotic formulations on outcomes of preterm, low-birth-weight neonates, we found moderate to high evidence for the superiority of combinations of 1 or more Lactobacillus spp and 1 or more Bifidobacterium spp vs single- and other multiple-strain probiotic treatments. The combinations of Bacillus spp and Enterococcus spp, and 1 or more Bifidobacterium spp and Streptococcus salivarius subsp thermophilus, might produce the largest reduction in NEC development. Further trials are needed.