Probiotics for prevention of necrotizing enterocolitis in preterm infants: systematic review and meta-analysis.
Probiotics for prevention of necrotizing enterocolitis in preterm infants: systematic review and meta-analysis.
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DOI：
10.1186/s13052-015-0199-2
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发表时间：
2015-11-14
影响因子：
3.6
通讯作者：
Italian Society of Neonatology
中科院分区：
文献类型：
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作者：
Aceti A;Gori D;Barone G;Callegari ML;Di Mauro A;Fantini MP;Indrio F;Maggio L;Meneghin F;Morelli L;Zuccotti G;Corvaglia L;Italian Society of Neonatology
坏死性小肠结肠炎（NEC）主要影响早产儿，他们有导致肠道生态失调的特定风险因素。通过益生菌操纵肠道微生物群有可能预防NEC。这项系统性综述和荟萃分析的目的是评估益生菌对早产儿NEC预防的作用，重点关注特定菌株、目前可用研究的微生物学强度和高危人群。检索PubMed和科克伦图书馆中2015年2月4日发表的试验。随机对照试验报告NEC和涉及早产儿谁给予益生菌在生命的第一个月被纳入系统性审查。26项研究适合纳入荟萃分析。由两名观察员独立提取和总结有关研究设计、人群、干预和结局的数据。研究质量和证据质量也进行了评价。使用固定效应模型和存在显著异质性的随机效应模型。进行亚组分析以探索研究间异质性的来源。结果表示为风险比（RR）和95%置信区间（CI）。主要结局为根据Bell标准NEC分期≥2期的发生率。益生菌预防早产儿NEC（RR 0.47 [95% CI 0.36-0.60]，p < 0.00001）。菌株特异性亚荟萃分析显示，双歧杆菌（RR 0.24 [95% CI 0.10-0.54]，p = 0.0006）和益生菌混合物（RR 0.39 [95% CI 0.27-0.56]，p < 0.00001）具有显著效果。益生菌可预防极低出生体重儿的NEC（RR 0.48 [95% CI 0.37-0.62]，p < 0.00001）;极低出生体重儿的数据不足。大多数研究显示了严重或中度的微生物缺陷。益生菌对早产儿NEC有整体预防作用。然而，在推荐广泛使用这些产品之前，关于要使用的特定益生菌菌株以及益生菌在高危人群（如极低出生体重婴儿）中的作用的数据仍然不足。
Necrotizing enterocolitis (NEC) affects predominantly preterm infants, who have specific risk factors leading to intestinal dysbiosis. Manipulations of gut microbiota through probiotics have the potential to prevent NEC. The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for NEC prevention in preterm infants, with a focus on specific strains, microbiological strength of currently available studies, and high-risk populations. PubMed and the Cochrane Library were searched for trials published within 4th February 2015. Randomized-controlled trials reporting on NEC and involving preterm infants who were given probiotics in the first month of life were included in the systematic review. Twenty-six studies were suitable for inclusion in the meta-analysis. Data about study design, population, intervention and outcome were extracted and summarized independently by two observers. Study quality and quality of evidence were also evaluated. Fixed-effects models were used and random-effects models where significant heterogeneity was present. Subgroup analyses were performed to explore sources of heterogeneity among studies. Results were expresses as risk ratio (RR) with 95 % confidence interval (CI). The main outcome was incidence of NEC stage ≥2 according to Bell’s criteria. Probiotics prevented NEC in preterm infants (RR 0.47 [95 % CI 0.36–0.60], p < 0.00001). Strain-specific sub-meta-analyses showed a significant effect for Bifidobacteria (RR 0.24 [95 % CI 0.10–0.54], p = 0.0006) and for probiotic mixtures (RR 0.39 [95 % CI 0.27–0.56], p < 0.00001). Probiotics prevented NEC in very-low-birth-weight infants (RR 0.48 [95 % CI 0.37–0.62], p < 0.00001); there were insufficient data for extremely-low-birth-weight infants. The majority of studies presented severe or moderate microbiological flaws. Probiotics had an overall preventive effect on NEC in preterm infants. However, there are still insufficient data on the specific probiotic strain to be used and on the effect of probiotics in high-risk populations such as extremely-low-birth-weight infants, before a widespread use of these products can be recommended.