Probiotic associations in the prevention of necrotising enterocolitis and the reduction of late-onset sepsis and neonatal mortality in preterm infants under 1500 g. A systematic review

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• 作者：Benjamin James Baucells^a ; Maria Mercadal Hally^b ; Airam Tenesor Á ; lvarez Sá ; nchez^c ; Josep Figueras Aloy^c ; ^{jfiguer@clinic.ub.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Very-low birth weight infants ; Necrotising enterocolitis ; Probiotics ; Premature infant ; Mortality ; Late-onset sepsis
• 刊名：Anales de Pediatría (English Edition)
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：85
• 期：5
• 页码：247-255
• 全文大小：722 K

文摘

Necrotising enterocolitis (NEC) is one of the most common and serious acquired bowel diseases a premature newborn can face. This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500 g.

Methods

A systematic review of randomised controlled trials, between January 1980 and March 2014, on MEDLINE, the Cochrane Central Register of Controlled Trials, together with EMBASE, was carried out. Studies with infants <1500 g or <34 weeks were selected, discarding those with Jadad scores lower than 4.

Results

9 studies were selected for further investigation, pooling a total of 3521 newborns. Probiotics were found to reduce the NEC incidence (RR 0.39; 95% CI: 0.26&ndash;0.57) and mortality (RR 0.70; 95% CI: 0.52&ndash;0.93), with no difference to placebo regarding late-onset sepsis (RR 0.91; 95% CI: 0.78&ndash;1.06). Finally, when analysing the different strands, the use of a 2-probiotic combination (Lactobacillus acidophilus with Bifidobacterium bifidum) proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations (RR 0.32; 95% CI: 0.15&ndash;0.66, NNT 20; 95% CI: 12&ndash;50).

Conclusions

Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates. Moreover, the combination of 2 probiotics (L. acidophilus with B. bifidum) seems to produce the greatest benefits. However, due to the differences in probiotic components and administration, it would be wise to perform a randomised controlled trial comparing different probiotic mixtures.