郭明 1唐晓宇 2叶远 3牛佳兰 2寇城坤 3马彬 2张雪峰3
作者信息
- 1. 解放军第302医院新生儿科 北京，100039
- 2. 兰州大学循证医学中心，兰州大学基础医学院 兰州，730000
- 3. 甘肃省循证医学与临床转化重点实验室 兰州，730000
- 折叠
摘要
Abstract
Objective To systematically evaluate the efficacy and safety of prophylactic probiotic supplementation for preventing necrotizing enterocolitis( NEC ) in preterm neonates. Methods Databases including PubMed,Ovid-EMbase,The Cochrane Library,CNKI,WanFang Data and VIP were searched to collect RCTs about probiotics for preventing necrotizing enterocolitis in preterm neonates up to March 2016. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Meta-analysis was conducted by RevMan 5. 3 software. Results A total of 33 RCTs,involving 8 248 patients were included. The results of meta-analysis showed that,for low birth weight infants( LBWI ),probiotics could significantly reduce the incidence of NEC( stage Ⅱ or more),the incidence of severe NEC( stageⅢ),time to full enteral feeds [the incidence of NEC:OR=0. 26(95%CI:0. 10 to 0. 66),P=0. 004;the incidence of severe NEC:OR=0. 29(95%CI:0. 11 to 0. 78),P=0. 01;time to full enteral feeds:WMD= -3. 57(95%CI:-5. 79 to -1. 34),P=0. 002],but did not decrease overall mortality and the risk for sepsis[overall mortality:OR=0. 80(95%CI:0. 50 to 1. 28),P=0. 35;the risk for sepsis:OR=0. 50 (95%CI:0.13 to 1. 99),P =0. 33];for very low birth weight infants(VLBWI),probiotic supplement was associated with a significantly decreased incidence of NEC and severe NEC,overall mortality,NEC related mortality,the risk for sepsis[ the <br> incidence of NEC:OR=0. 34(95%CI:0. 26 to 0. 44),P﹤0. 000 01;the incidence of severe NEC:OR=0. 39(95%CI:0. 20 to 0. 76),P=0. 006;overall mortality:OR=0. 55(95%CI:0. 44 to 0. 69),P﹤0. 000 01;NEC related mortality:OR=0. 38(95%CI:0. 21 to 0. 69),P=0. 001;the risk for sepsis:OR=0. 77(95%CI:0. 62 to 0. 95),P=0. 02]. There was no evidence of significant reduction of time to full enteral feeds[WMD= -1. 28(95%CI:-2. 62 to 0. 06),P=0. 06];for extreme low birth weight infants ( ELBWI),probiotics administration didnˊt decrease the incidence of NEC and severe NEC,overall mortality,NEC related mortality,the risk for sepsis[the incidence of NEC:OR=0. 67(95%CI:0. 25 to 1. 79),P=0. 43;the incidence of severe NEC:OR=1. 02(95%CI:0. 14 to 7. 54),P =0. 98;overall mortality:OR =0. 96(95%CI:0. 34 to1. 43),P =0. 32;NEC related mortality:OR=0. 73(95%CI:0. 12 to 4. 48),P=0. 74;the risk for sepsis:OR=0. 50(95%CI:0. 20 to 1. 23),P=0. 13],but could significantly shorten time to full enteral feeds [ WMD = - 1. 70( 95% CI:- 2. 85 to - 0. 55 ),P = 0. 004 ]. Conclusion Probiotic supplement could reduce risk of NEC and time to full enteral feeds in LBWI and VLBW,and showed a decreasing trend of mortality and the risk for sepsis. The above conclusions need more high quality studies to be verified.关键词
益生菌/坏死性小肠结肠炎/早产儿/系统评价/Meta分析/随机对照试验Key words
Probiotics/Necrotizingenterocolitis/Prematureinfant/Systematicreview/Meta-analysis/Randomizedcontrolledtrial
