A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates.
A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates.
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DOI：
10.1590/1414-431x20143857
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发表时间：
2014-09
期刊：
影响因子：
--
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Yang Y;Guo Y;Kan Q;Zhou XG;Zhou XY;Li Y
坏死性小肠结肠炎（NEC）是早产儿消化道最常见的获得性疾病之一。一些随机对照试验（RCTs）表明，益生菌可能潜在地降低NEC的发病率和死亡率。然而，关于益生菌的安全性及其对婴儿正常生长的影响仍存在争议。我们进行了这项荟萃分析，以评估补充益生菌对早产儿的安全性和益处。我们在PubMed、Embase和Cochrane数据库中检索英文文献，在万方、VIP和CNKI数据库中检索中文文献。最终，27项随机对照试验（包括9篇中文文章）被纳入本meta分析。根据数据类型和异质性，采用随机效应或固定效应模型计算相对风险（RR）和加权平均差（WMD）。共有6655名早产儿，包括益生菌组（n=3298）和安慰剂组（n=3357），符合纳入本荟萃分析的条件。对于Bell期≥I、胎龄<37周的孕妇，益生菌组NEC发病风险显著降低[RR=0.35, 95%可信区间(CI)=0.27 ~ 0.44， P<0.00001]。对于Bell期≥II或胎龄<34周，益生菌组和安慰剂组在NEC发生率方面也有同样的显著差异（RR=0.34, 95%CI=0.25-0.48， P<0.00001； RR=0.39, 95%CI=0.27-0.56， P<0.00001）。益生菌组的死亡风险显著降低（RR=0.58, 95%CI=0.46-0.75， P<0.0001）。两组脓毒症发生风险差异无统计学意义（RR=0.94, 95%CI=0.83-1.06， P=0.31）。在体重增加和婴儿达到完全喂养的年龄方面，益生菌组和安慰剂组之间没有显著差异（WMD=1.07, 95%CI= - 0.21-2.34， P=0.10； WMD= - 1.66, 95%CI= - 3.6-0.27， P=0.09）。该荟萃分析表明，无论胎龄和NEC分期如何，补充益生菌都可以显著降低早产儿NEC的风险。分析还表明，这种补充不会增加败血症或死亡率的发生率。最后，研究表明，补充益生菌对正常饲养和生长没有不良影响。
Necrotizing enterocolitis (NEC) is one of the most common acquired diseases of the gastrointestinal tract in preterm infants. Some randomized, controlled trials (RCTs) have indicated that probiotics may potentially lower the incidence of NEC and mortality. However, debate still remains about the safety of probiotics and their influence on normal infant growth. We performed this meta-analysis to assess the safety and benefits of probiotic supplementation in preterm infants. We searched in PubMed, Embase, and Cochrane databases for English references, and in Wanfang, VIP, and CNKI databases for Chinese references. Ultimately, 27 RCTs (including 9 Chinese articles) were incorporated into this meta-analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity. A total of 6655 preterm infants, including the probiotic group (n=3298) and the placebo group (n=3357), were eligible for inclusion in this meta-analysis. For Bell stage ≥I and gestational age <37 weeks, risk of NEC incidence was significantly lower in the probiotic group [RR=0.35, 95% confidence interval (CI)=0.27-0.44, P<0.00001]. For Bell stage ≥II or gestational age <34 weeks, there were likewise significant differences between the probiotic and placebo groups concerning NEC incidence (RR=0.34, 95%CI=0.25-0.48, P<0.00001; and RR=0.39, 95%CI=0.27-0.56, P<0.00001). Risk of death was significantly reduced in the probiotic group (RR=0.58, 95%CI=0.46-0.75, P<0.0001). In contrast, there was no significant difference concerning the risk of sepsis (RR=0.94, 95%CI=0.83-1.06, P=0.31). With respect to weight gain and the age at which infants reached full feeds, no significant differences were found between the probiotic and placebo groups (WMD=1.07, 95%CI=−0.21-2.34, P=0.10; and WMD=−1.66, 95%CI=−3.6-0.27, P=0.09). This meta-analysis has shown that, regardless of gestational age and NEC stage, probiotic supplementation could significantly reduce the risk of NEC in preterm infants. Analysis also indicated that such supplementation did not increase the incidence risk of sepsis or of mortality. Finally, the study showed that probiotic supplementation may have no adverse effect on normal feeding and growth.
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DOI：
10.1136/archdischild-2011-300435
发表时间：
2013-01-01
影响因子：
4.4
作者：
Alberto Fernandez-Carrocera, Luis;Solis-Herrera, Aide;Leticia Echaniz-Aviles, Maria Olga
通讯作者：
Leticia Echaniz-Aviles, Maria Olga
影响因子：
7.1
作者：
Braga, Taciana Duque;Pontes da Silva, Giselia Alves;Lima, Marilia de Carvalho
通讯作者：
Lima, Marilia de Carvalho
影响因子：
2.5
作者：
Costalos, C;Skouteri, V;Petroehilou, V
通讯作者：
Petroehilou, V
影响因子：
105.7
作者：
Campbell, MK;Elbourne, DR;Altman, DG
通讯作者：
Altman, DG
DOI：
10.1056/nejmra1005408
发表时间：
2011-01-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
Neu J;Walker WA
通讯作者：
Walker WA