口咽初乳对坏死性小肠结肠炎发生率影响的系统评价和Meta分析OA北大核心

Background Previous randomized controlled trials(RCTs)and meta-analyses investigating the effect of oropharyngeal colostrum on the incidence of necrotizing enterocolitis(NEC)have reported inconsistent conclusions.Objective To systematically review the literature,update the meta-analysis,and evaluate the efficacy of oropharyngeal colostrum in reducing the incidence of NEC.Design Systematic review/meta-analysis Methods English databases(PubMed,Embase,Web of Science,Cochrane Library)and Chinese databases(CNKI,Wanfang,VIP,Chinese Medical Journal Full-Text Database)were searched from inception to January 8,2025.RCTs in English or Chinese were included if they enrolled neonates with gestational age＜37 weeks(regardless of birth weight),compared oropharyngeal colostrum(administered via swabbing,drops,or other methods)with control interventions(sterile water,saline,or routine care),and reported NEC(stage Ⅱ or above)as an outcome.Two researchers independently screened studies,extracted data,and assessed risk of bias using the Cochrane Risk of Bias Tool(version 6.1).Main outcome measures NEC(stage Ⅱ or above).Results Twenty-seven RCTs(18 English,9 Chinese)involving 2,950 neonates(intervention:1,462;control:1,488)were included.The majority of studies used 0.2 mL of colostrum(89％),administered every 2-4 hours(85％),for 3-7 days(70％).Meta-analysis using random effects model or fixed-effects model showed a statistically significant reduction in NEC(stage Ⅱ or above)incidence in the intervention group(65/1,462)compared to controls(147/1,488)(OR=0.44,95％CI:0.32-0.61,P＜0.01).Funnel plot analysis indicated no significant publication bias.Secondary outcomes:Oropharyngeal colostrum reduced neonatal sepsis(OR=0.55,95％CI:0.42-0.72),feeding intolerance(OR=0.46,95％CI:0.27-0.78),and ventilator-associated pneumonia(VAP)(OR=0.51,95％CI:0.29-0.92).It also shortened time to full enteral feeding(-2.50 d,95％CI:-4.08--0.91),hospital stay(-4.43 d,95％CI:-6.32--2.54),and duration of antibiotic use(-2.56 d,95％CI:-4.12--1.01).No significant differences were observed in all-cause mortality,intraventricular hemorrhage(IVH),chronic lung disease(CLD),or retinopathy of prematurity(ROP).Conclusion Oropharyngeal colostrum reduces the incidence of NEC,neonatal sepsis,VAP,and feeding intolerance in preterm infants,while shortening time to full enteral feeding,hospitalization duration,and antibiotic use.