Prophylactic Probiotics for Preterm Infants: A Systematic Review and Meta-Analysis of Observational Studies
Prophylactic Probiotics for Preterm Infants: A Systematic Review and Meta-Analysis of Observational Studies
复制标题
早产儿预防性益生菌：观察研究的系统回顾和荟萃分析
作者：
R. Olsen;G. Greisen;M. Schrøder;J. Brok
背景：坏死性小肠结肠炎（NEC）是早产儿的主要发病率和死亡原因。益生菌似乎对预防 NEC 具有有益作用，随机对照试验 (RCT) 的荟萃分析证实了这一点。因此，我们的目的是回顾并确认观察性研究中获得的益生菌对早产儿的功效。目的：评估预防性益生菌对早产儿的作用。方法：通过检索 PubMed、EMBASE、CENTRAL（Cochrane 图书馆）和 www.clinicaltrials.gov 进行荟萃分析。还检索了随机对照试验综述的参考列表。纳入的研究是纳入胎龄 <37 周的早产儿的观察性研究。如果他们服用任何益生菌并测量至少一种临床结果（例如 NEC、全因死亡率、败血症或长期发育评分），则纳入试验。两位作者从纳入的研究中提取了特征和结果。纽卡斯尔-渥太华量表用于质量评估。使用随机效应荟萃分析模型，并通过 I2 检验评估异质性。结果：我们纳入了 12 项研究，涉及 10,800 名早产新生儿（其中 5,144 名接受预防性益生菌，5,656 名对照组）。荟萃分析显示 NEC 的发生率（风险比，RR = 0.55，95% 置信区间，95% CI，0.39-0.78；p = 0.0006）和死亡率（RR = 0.72，95% CI，0.61-0.85；p < 0.0001）显着降低。脓毒症在两组之间没有显着差异（RR = 0.86，95% CI，0.74-1.00；p = 0.05）。结论：补充益生菌可降低早产儿 NEC 和死亡率的风险。效应大小与随机对照试验荟萃分析的结果相似。然而，最佳菌株、剂量和时间需要进一步研究。
Background: Necrotizing enterocolitis (NEC) is a major morbidity and cause of mortality in preterm neonates. Probiotics seem to have a beneficial role in preventing NEC, which is confirmed in meta-analyses of randomized controlled trials (RCTs). We therefore aimed to review and confirm the efficacy of probiotics in preterm neonates obtained in observational studies. Objective: To assess the effects of prophylactic probiotics in preterm infants. Methods: A meta-analysis was performed searching PubMed, EMBASE, CENTRAL (the Cochrane Library) and www.clinicaltrials.gov. Reference lists of reviews of RCTs were also searched. Included studies were observational studies that enrolled preterm infants <37 weeks of gestational age. Trials were included if they administered any probiotics and measured at least one clinical outcome (e.g. NEC, all-cause mortality, sepsis or long-term development scores). Two authors extracted characteristics and outcomes from included studies. The Newcastle-Ottawa Scale was used for quality assessment. A random-effects meta-analysis model was used, and heterogeneity was assessed by the I2 test. Results: We included 12 studies with 10,800 premature neonates (5,144 receiving prophylactic probiotics and 5,656 controls). The meta-analysis showed a significantly decreased incidence of NEC (risk ratio, RR = 0.55, 95% confidence interval, 95% CI, 0.39-0.78; p = 0.0006) and mortality (RR = 0.72, 95% CI, 0.61-0.85; p < 0.0001). Sepsis did not differ significantly between the two groups (RR = 0.86, 95% CI, 0.74-1.00; p = 0.05). Conclusions: Probiotic supplementation reduces the risk of NEC and mortality in preterm infants. The effect sizes are similar to findings in meta-analyses of RCTs. However, the optimal strain, dose and timing need further investigation.