{"title":"Cochrane综述:益生菌预防早产儿坏死性小肠结肠炎","authors":"Khalid AlFaleh, Jasim Anabrees, Dirk Bassler, Turki Al-Kharfi","doi":"10.1002/ebch.1881","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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 associated morbidity.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC and/or sepsis in preterm infants.</p>\n </section>\n \n <section>\n \n <h3> Search methods</h3>\n \n <p>For this update, searches were made of MEDLINE (1966 to October 2010), EMBASE (1980 to October 2010), the Cochrane Central Register of Controlled Trials <i>(</i>CENTRAL, <i>The Cochrane Library,</i> Issue 2, 2010), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010).</p>\n </section>\n \n <section>\n \n <h3> Selection criteria</h3>\n \n <p>Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age and/or < 2500 g birth weight were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.</p>\n </section>\n \n <section>\n \n <h3> Data collection and analysis</h3>\n \n <p>Standard methods of the Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials, data collection and analysis.</p>\n </section>\n \n <section>\n \n <h3> Main results</h3>\n \n <p>Sixteen eligible trials randomizing 2842 infants were included. Included trials were highly variable with regard to enrollment criteria (i.e. birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. Data regarding extremely low birth weight infants (ELBW) could not be extrapolated. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical RR 0.35, 95% CI 0.24 to 0.52) and mortality (typical RR 0.40, 95% CI 0.27 to 0.60). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.90, 95% CI 0.76 to 1.07). The included trials reported no systemic infection with the probiotics supplemental organism. The statistical test of heterogeneity for NEC, mortality and sepsis was insignificant.</p>\n </section>\n \n <section>\n \n <h3> Authors' conclusions</h3>\n \n <p>Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence supports a change in practice. More studies are needed to assess efficacy in ELBW infants and assess the most effective formulation and dose to be utilized.</p>\n </section>\n \n <section>\n \n <h3> Plain Language Summary</h3>\n \n <p><b>Probiotics for prevention of necrotizing enterocolitis in preterm infants</b></p>\n \n <p>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 less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants less than 1000 grams at birth.</p>\n </section>\n </div>","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":"7 6","pages":"1807-1854"},"PeriodicalIF":0.0000,"publicationDate":"2012-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1881","citationCount":"0","resultStr":"{\"title\":\"Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants\",\"authors\":\"Khalid AlFaleh, Jasim Anabrees, Dirk Bassler, Turki Al-Kharfi\",\"doi\":\"10.1002/ebch.1881\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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 associated morbidity.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC and/or sepsis in preterm infants.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Search methods</h3>\\n \\n <p>For this update, searches were made of MEDLINE (1966 to October 2010), EMBASE (1980 to October 2010), the Cochrane Central Register of Controlled Trials <i>(</i>CENTRAL, <i>The Cochrane Library,</i> Issue 2, 2010), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Selection criteria</h3>\\n \\n <p>Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age and/or < 2500 g birth weight were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Data collection and analysis</h3>\\n \\n <p>Standard methods of the Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials, data collection and analysis.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Main results</h3>\\n \\n <p>Sixteen eligible trials randomizing 2842 infants were included. Included trials were highly variable with regard to enrollment criteria (i.e. birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. Data regarding extremely low birth weight infants (ELBW) could not be extrapolated. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical RR 0.35, 95% CI 0.24 to 0.52) and mortality (typical RR 0.40, 95% CI 0.27 to 0.60). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.90, 95% CI 0.76 to 1.07). The included trials reported no systemic infection with the probiotics supplemental organism. The statistical test of heterogeneity for NEC, mortality and sepsis was insignificant.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Authors' conclusions</h3>\\n \\n <p>Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence supports a change in practice. More studies are needed to assess efficacy in ELBW infants and assess the most effective formulation and dose to be utilized.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Plain Language Summary</h3>\\n \\n <p><b>Probiotics for prevention of necrotizing enterocolitis in preterm infants</b></p>\\n \\n <p>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 less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants less than 1000 grams at birth.</p>\\n </section>\\n </div>\",\"PeriodicalId\":12162,\"journal\":{\"name\":\"Evidence-based child health : a Cochrane review journal\",\"volume\":\"7 6\",\"pages\":\"1807-1854\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2012-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1002/ebch.1881\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Evidence-based child health : a Cochrane review journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ebch.1881\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Evidence-based child health : a Cochrane review journal","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ebch.1881","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:坏死性小肠结肠炎(NEC)和院内败血症与早产儿发病率和死亡率增加有关。预防性肠内益生菌(活微生物补充剂)可以通过防止细菌在粘膜上的迁移、竞争性排除致病菌和增强宿主的免疫反应,在减少NEC和相关发病率方面发挥作用。目的比较预防性肠内益生菌与安慰剂或不治疗预防早产儿严重NEC和/或败血症的疗效和安全性。检索方法:检索MEDLINE(1966年至2010年10月)、EMBASE(1980年至2010年10月)、Cochrane中央对照试验登记册(Central, the Cochrane Library,第2期,2010年)和儿科研究学会年会摘要(1995年至2010年)。选择标准:仅纳入早产儿的随机或准随机对照试验;37周孕龄和/或<2,500 g出生体重。如果试验涉及肠内给药任何活微生物补充剂(益生菌)并测量至少一个预先指定的临床结果,则纳入试验。采用Cochrane协作网及其新生儿组的标准方法评估试验、数据收集和分析的方法学质量。主要结果纳入16项符合条件的试验,随机选取2842名婴儿。纳入的试验在入组标准(即出生体重和胎龄)、对照组NEC基线风险、时间、剂量、益生菌制剂和喂养方案方面变化很大。关于极低出生体重婴儿(ELBW)的数据无法推断。在试验数据的荟萃分析中,补充肠道益生菌可显著降低严重NEC (II期或以上)的发生率(典型RR 0.35, 95% CI 0.24至0.52)和死亡率(典型RR 0.40, 95% CI 0.27至0.60)。没有证据表明院内败血症显著减少(典型RR 0.90, 95% CI 0.76 ~ 1.07)。纳入的试验报告益生菌补充菌没有全身性感染。NEC、死亡率和败血症的异质性统计检验不显著。作者的结论肠内补充益生菌可以预防早产儿严重NEC和全因死亡。我们对现有证据的最新回顾支持实践的改变。需要更多的研究来评估低体重婴儿的疗效,并评估最有效的配方和剂量。摘要益生菌预防早产儿坏死性小肠结肠炎(坏死性小肠结肠炎)是一种严重的疾病,在生命的最初几周内影响早产儿的肠道。虽然NEC的病因尚不完全清楚,但母乳喂养和细菌生长起了一定作用。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,使用益生菌可以减少出生体重小于1500克的早产儿NEC的发生和死亡。关于对出生时体重小于1000克的高危婴儿的益处和潜在不良影响的数据不足。
Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants
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 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 and/or sepsis in preterm infants.
Search methods
For this update, searches were made of MEDLINE (1966 to October 2010), EMBASE (1980 to October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2010), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2010).
Selection criteria
Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age and/or < 2500 g birth weight 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, data collection and analysis.
Main results
Sixteen eligible trials randomizing 2842 infants were included. Included trials were highly variable with regard to enrollment criteria (i.e. birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. Data regarding extremely low birth weight infants (ELBW) could not be extrapolated. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical RR 0.35, 95% CI 0.24 to 0.52) and mortality (typical RR 0.40, 95% CI 0.27 to 0.60). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.90, 95% CI 0.76 to 1.07). The included trials reported no systemic infection with the probiotics supplemental organism. The statistical test of heterogeneity for NEC, mortality and sepsis was insignificant.
Authors' conclusions
Enteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence supports a change in practice. More studies are needed to assess efficacy in ELBW infants and assess the most effective formulation and dose 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 less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants less than 1000 grams at birth.