Probiotics for prevention of necrotizing enterocolitis in preterm infants.
Probiotics for prevention of necrotizing enterocolitis in preterm infants.
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DOI：
10.1002/ebch.1976
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发表时间：
2014-09-01
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影响因子：
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通讯作者：
Anabrees, Jasim
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作者：
AlFaleh, Khalid;Anabrees, Jasim
背景：坏死性小肠结肠炎（NEC）和院内感染与早产儿发病率和死亡率增加有关。预防性肠道益生菌通过防止细菌穿过粘膜迁移、竞争性排除致病菌和增强宿主的免疫应答，（活微生物补充剂）可能在降低NEC和相关发病率方面发挥作用。为了比较预防性肠内益生菌给药与安慰剂或不治疗在预防严重NEC或脓毒症或两者中的有效性和安全性，方法：对于本次更新，检索了MEDLINE（1966年至2013年10月），EMBASE（1980年至2013年10月），科克伦图书馆中的科克伦对照试验中心注册中心（CENTRAL）（2013年，第10期）和儿科研究学会年会摘要（1995年至2013年）。只有随机或准随机对照试验，纳入早产儿< 37周胎龄或< 2500 g出生体重，或两者，被考虑。试验包括，如果他们涉及任何活的微生物补充剂（益生菌）肠内给药，并测量至少一个预先指定的临床outcome.DATA收集和分析：标准方法的科克伦协作和新生儿组被用来评估的试验方法学质量和数据收集和analysis.Main结果：24个合格的试验被列入。纳入的试验在入组标准（即出生体重和胎龄）、对照组NEC的基线风险、时间、剂量、益生菌制剂和喂养方案方面存在高度差异。在一项试验数据的荟萃分析中，肠内益生菌补充显著降低了重度NEC的发生率（II期或以上）（典型相对风险（RR）0.43，95%置信区间（CI）0.33 - 0.56; 20项研究，5529名婴儿）和死亡率（典型RR 0.65，95% CI 0.52 - 0.81; 17项研究，5112名婴儿）。没有证据表明医院内败血症的发生率显著降低（典型RR 0.91，95% CI 0.80 - 1.03; 19项研究，5338名婴儿）。纳入的试验报告没有补充益生菌生物体的全身感染。益生菌制剂含有单独的或与双歧杆菌的组合被发现是有效的。益生菌的结论：肠内补充益生菌预防严重NEC和早产儿的所有原因死亡。我们对现有证据的最新审查强烈支持实践的改变。头对头的比较研究，需要评估最有效的准备工作，时间，和治疗的长度要used.Plain语言摘要：益生菌预防早产儿坏死性小肠结肠炎（NEC）是一种严重的疾病，影响肠道的早产儿在最初几个星期的生活。虽然NEC的原因还不完全清楚，但牛奶喂养和细菌生长起着作用。益生菌（含有潜在有益细菌或酵母的膳食补充剂）已被用于预防NEC。我们对研究的回顾发现，益生菌的使用减少了出生体重低于1500克的早产儿NEC和死亡的发生。关于出生时体重低于1000克的高危婴儿的获益和潜在不良反应的数据不足。
BACKGROUND: Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity.OBJECTIVES: To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants.SEARCH METHODS: For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013).SELECTION CRITERIA: Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.DATA COLLECTION AND ANALYSIS: Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis.MAIN RESULTS: Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotics organism. Probiotics preparations containing either lactobacillus alone or in combination with bifidobacterium were found to be effective.AUTHORS' CONCLUSIONS: Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice. Head to head comparative studies are required to assess the most effective preparations, timing, and length of therapy to be utilized.PLAIN LANGUAGE SUMMARY: Probiotics for prevention of necrotizing enterocolitis in preterm infants Necrotizing enterocolitis (NEC) is a serious disease that affects the bowel of premature infants in the first few weeks of life. Although the cause of NEC is not entirely known, milk feeding and bacterial growth play a role. Probiotics (dietary supplements containing potentially beneficial bacteria or yeast) have been used to prevent NEC. Our review of studies found that the use of probiotics reduces the occurrence of NEC and death in premature infants born weighing less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants weighing less than 1000 grams at birth.