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Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants

  • Review
  • Intervention

Authors


Abstract

Background

Necrotizing enterocolitis (NEC) is the most common gastrointestinal problem of preterm neonates. There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis. This systematic review was undertaken to clarify the issue.

Objectives

To evaluate the benefits and harms of enteral antibiotic prophylaxis for necrotizing enterocolitis in low birth weight and preterm infants.

Search methods

Searches were made of the Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2006), MEDLINE (1966 - July 2006), EMBASE (1988 - July 2006) and CINAHL (1982 - July 2006) previous reviews with cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the fields of neonatal pediatrics and microbiology.

Selection criteria

All randomized or quasi-randomized controlled trials where enteral antibiotics were used as prophylaxis against NEC in LBW (< 2500 g) and/or preterm (< 37 weeks gestation) infants.

Data collection and analysis

The standard method of the Cochrane Collaboration and its Neonatal Review Group was used. The methodological quality of each trial was reviewed by the second author who was blinded to the trial authors and institutions. Each author extracted data separately before comparison and resolution of differences. Relative risk (RR), risk difference (RD), and number needed to treat were used in the analysis.

Main results

Five eligible trials involving 456 infants were included. The administration of prophylactic enteral antibiotics resulted in a statistically significant reduction in NEC [typical RR 0.47 (0.28, 0.78); typical RD -0.10 (-0.16, -0.04); NNT 10 (6, 25)].

There was a statistically significant reduction in NEC-related deaths [typical RR 0.32 (0.10, 0.96); typical RD -0.07 (-0.13, 0.01); NNT 14 (8, 100)].

There was a trend towards a reduction in all deaths which was not significant [typical RR 0.67(0.34, 1.32)].

There were no significant differences in NEC-like enteropathies (one trial only).

One study found a statistically significant increase in the incidence of colonization with resistant bacteria and the summary analysis of three trials gave an increase which was just significant [RR 1.73 (1.00, 2.97); RD 0.07 (0.00, 0.13)].

Authors' conclusions

Evidence suggests that oral antibiotics reduce the incidence of NEC in low birth weight infants. However concerns about adverse outcomes persist, particularly related to the development of resistant bacteria. To address this question further, a large trial would be required with a sample size sufficient to examine all the important benefits and harms. Adverse outcomes associated with infection should be evaluated, and microbiological studies looking for the development of resistant bacteria should be undertaken

摘要

背景

腸道抗生素預防低出生體重兒或早產兒壞死性小腸結腸炎

壞死性小腸結腸炎(NEC)是早產新生兒中最常見的胃腸道疾病。已有報告發表,使用腸道抗生素可能可以有效的預防NEC。本系統性回顧就該問題予以釐清。

目標

評估腸道抗生素預防低出生體重和早產兒壞死性小腸結腸炎的利弊。

搜尋策略

檢索Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library,2006年第3期),MEDLINE(1966年至2006年7月),EMBASE(1988年年至2006年7月),CINAHL(1982年至2004年7月),含之前回顧的參考文獻,摘要,會議與研討會論文集,專家訊息,並對新生兒兒科學和微生物學領域的雜誌進行手工檢索。

選擇標準

所有應用腸道抗生素預防低出生體重(小於2500克)和/或早產兒(胎齡小於37週)壞死性小腸結腸炎的隨機或小型隨機對照試驗。

資料收集與分析

以Cochrane Collaboration及其Neonatal Review Group的標準方法。由第二位作者(他不知道試驗的作者和機構單位)對每項試驗進行方法學質量評價。每位作者分別提取數據,然後進行比較和解決分歧。以相對風險(RR),風險差(RD)和需治療人數(NNT)進行分析。

主要結論

納入共456名嬰兒參與的5項合格試驗。腸道抗生素預防性用藥使NEC有統計學顯著降低[典型RR 0.47(0.28,0.78);典型RD −0.10(−0.16,−0.04);NNT 10(6,25)。NEC相關死亡有統計上顯著下降[典型RR 0.32 (0.10, 0.96); 典型RD −0.07 (−0.13, 0.01); NNT 14 (8,100)]。所有死亡有下降傾向但不顯著[典型RR 0.67(0.34, 1.32)]。類NEC的腸病變沒顯著差異(只有一項試驗).一項試驗發現抗藥性菌種菌落產生率有統計上顯著增加。在3項試驗的統合分析剛好濱臨顯著的增加[RR 1.73 (1.00, 2.97); RD 0.07(0.00, 0.13)].

作者結論

證據顯示口服抗生素可降低低出生體重兒壞死性小腸結腸炎的發生率。然而,對不良結果的憂慮依然存在,特別是有關抗藥性細菌的產生。為進一步解決這個問題,有必要開展樣本量足夠大的大規模試驗對所有重要利弊進行評估。應對與感染有關聯的不良結果進行評估,並應開展抗藥細菌產生的微生物學研究。

翻譯人

本摘要由臺中榮民總醫院葉惠英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠證據支持對低體重新生兒胃管灌抗生素,能預防壞死性小腸結腸炎。壞死性小腸結腸炎(NEC)是出生後的前幾週影響腸道的嚴重疾病。病因未明但可能與餵奶及細菌有關。NEC在早產兒較常見,或許因免疫力降低有關。口服抗生素曾被用於預防NEC但擔心口服抗生素的潛在不良效應如細菌抗藥性。本回顧發現沒有足夠證據支持在早產低體重嬰兒使用抗生素預防NEC。需要更多的研究評估。

Plain language summary

Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants

Not enough evidence to support administering antibiotics through a feeding tube for low birth weight and new born babies to prevent necrotizing enterocolitis. Necrotizing enterocolitis (NEC) is a serious disease that affects the bowel in the first few weeks of life. The cause is unknown but milk feeding and bacteria may contribute. NEC is more common in preterm babies, possibly because of reduced immunity. Oral antibiotics have been used to prevent NEC but there are concerns about the possible adverse effects of oral antibiotics such as resistance to bacteria. The review of trials found there was not enough evidence to support the use of antibiotics to prevent NEC in preterm and low birth weight babies. More research is needed.

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