两种益生菌制剂预防早产儿坏死性小肠结肠炎的效果比较
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摘要
目的:比较两种常用益生菌制剂对早产儿坏死性小肠结肠炎(NEC)发生率和病死率的影响。方法:选择2016-2017年在我院出生的早产儿167例,随机分为A组84例和B组83例,分别给予双歧杆菌四联活菌片(0. 25 g,1次/天)和双歧杆菌活菌散(0. 50 g,1次/天),连续服用至出院。比较两组患儿的病死率、Ⅱ期及以上NEC发生率、败血症发生率、全胃肠饮食(TPN)时间、住院时间、喂养不耐受次数。结果:A组和B组患儿服药时间分别为36(28,49) d和40(26,52) d,差异无统计学意义(P>0. 05);病死率分别为4. 76%(4/84)和16. 87%(14/83),差异有统计学意义(P<0. 05)。A组NEC、败血症死亡比例小于B组(P<0. 05);A组Ⅱ期及以上NEC发生率、TPN时间、喂养量达100 mL/d及150 mL/d的时间、喂养不耐受次数、喂养不耐受> 3次比例均小于或短于B组(P均<0. 05);两组患儿败血症发生率、住院时间比较差异均无统计学意义(P均>0. 05)。结论:双歧杆菌四联活菌片能有效降低早产儿NEC的发生率和病死率,疗效优于双歧杆菌活菌散。
Objective: To compare the effects of two kinds of probiotics on incidence and mortality of necrotizing enterocolitis( NEC in premature infants. Methods: Totally 167 premature infants born in our hospital from 2016 to 2017 were extracted to be randomly divided into group A( n = 84) and group B( n = 83),and bifidobacterium tetrad viable tablets( 0. 25 g,once a day) and bifidobacterium viable powder( 0. 5 g,once a day) were given respectively for continuous use until discharge. The mortality,incidence of NEC ≥ stage Ⅱ,incidence of septicemia,total parenteral nutrition( TPN) time,length of stay and feeding intolerance frequency were compared between two groups. Results: The medication time in group A and group B were respectively 36( 28,49) d and 40( 26,52) d,and the difference was not statistically significant( P>0. 05); the mortality rate was respectively 4. 76%( 4/84) and16. 87%( 14/83),the difference was statistically significant( P<0. 05). The proportion of death caused by NEC and sepsis in group A was lower than that in group B( P<0. 05). The incidence of NEC ≥ stage Ⅱ,TPN time,time of feeding amount to 100 mL/d and150 mL/d,feeding intolerance frequency and feeding intolerance > 3 times in group A were less than or shorter than those in group B( P<0. 05). There was no statistically significant difference between two groups in incidence of sepsis and length of stay( P> 0. 05).Conclusion: Bifidobacterium tetra viable tablets can effectively reduce the incidence and mortality of NEC,and its efficacy is better than bifidobacterium viable powder.
Objective: To compare the effects of two kinds of probiotics on incidence and mortality of necrotizing enterocolitis( NEC in premature infants. Methods: Totally 167 premature infants born in our hospital from 2016 to 2017 were extracted to be randomly divided into group A( n = 84) and group B( n = 83),and bifidobacterium tetrad viable tablets( 0. 25 g,once a day) and bifidobacterium viable powder( 0. 5 g,once a day) were given respectively for continuous use until discharge. The mortality,incidence of NEC ≥ stage Ⅱ,incidence of septicemia,total parenteral nutrition( TPN) time,length of stay and feeding intolerance frequency were compared between two groups. Results: The medication time in group A and group B were respectively 36( 28,49) d and 40( 26,52) d,and the difference was not statistically significant( P>0. 05); the mortality rate was respectively 4. 76%( 4/84) and16. 87%( 14/83),the difference was statistically significant( P<0. 05). The proportion of death caused by NEC and sepsis in group A was lower than that in group B( P<0. 05). The incidence of NEC ≥ stage Ⅱ,TPN time,time of feeding amount to 100 mL/d and150 mL/d,feeding intolerance frequency and feeding intolerance > 3 times in group A were less than or shorter than those in group B( P<0. 05). There was no statistically significant difference between two groups in incidence of sepsis and length of stay( P> 0. 05).Conclusion: Bifidobacterium tetra viable tablets can effectively reduce the incidence and mortality of NEC,and its efficacy is better than bifidobacterium viable powder.
引文
[1]ELGIN T G,KERN S L,MCELROY S J.Development of the neonatal intestinal microbiome and its association with necrotizing enterocolitis[J].Clin Ther,2016,38(4):706-715.
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[7]FALLON E M,NEHRA D,POTEMKIN A K,et al.A.S.P.E.N.clinical guidelines:Nutrition support of neonatal patients at risk for necrotizing enterocolitis[J].JPEN J Parenter Enteral Nutr,2012,36(5):506-523.
[8]NATHAN A T,WARD L,SCHIBLER K,et al.A quality improvement initiative to reduce necrotizing enterocolitis across hospital systems[J].J Perinatol,2018,38(6):742-750.
[9]RAJPUT N,FILIPOVSKA J,HEWSON M.The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants[J].Turk J Pediatr,2017,59(1):20-27.
[10]VAN DEN AKKER C H P,VAN GOUDOEVER J B,SZAJEWSKA H,et al.Probiotics for preterm infants:A strainspecific systematic review and network meta-analysis[J].JPediatr Gastroenterol Nutr,2018,67(1):103-122.
[11]林华仙.益生菌联合早期微量喂养预防新生儿坏死性小肠结肠炎效果分析[J].儿科药学杂志,2013,19(6):18-20.
[12]COSTELOE K,BOWLER U,BROCKLEHURST P,et al.Arandomised controlled trial of the probiotic Bifidobacterium breve BBG-001 in preterm babies to prevent sepsis,necrotising enterocolitis and death:The probiotics inpreterm infants(PiPS)trial[J].Health Technol Assess,2016,20(66):1-194.
[13]ALFALEH K,ANABREES J.Probiotics for prevention of necrotizing enterocolitis in preterm infants[J].Cochrane Database Syst Rev,2014,10(4):CD005496.
[14]BLACKWOOD B P,YUAN C Y,WOOD D R,et al.Probiotic lactobacillus species strengthen intestinal barrier function and tight junction integrity in experimental necrotizing enterocolitis[J].J Probiotics Health,2017,5(1):159.
[15]UBEROS J,AGUILERA-RODRíGUEZ E,JEREZ-CALERO A,et al.Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants[J].Br J Nutr,2017,117(7):994-1000.
[2]RODRIGUEZ J,JORDAN S,MUTIC A,et al.The neonatal microbiome:Implications for neonatal intensive care unit nurses[J].MCN Am J Matern Child Nurs,2017,42(6):332-337.
[3]NEU J.Necrotizing enterocolitis:The mystery goes on[J].Neonatology,2014,106(4):289-295.
[4]COURCHIA B,KURTOM W,PENSIRIKUL A,et al.Topiramate for seizures in preterm infants and the development of necrotizing enterocolitis[J].Pediatrics,2018,142(1):e20173971.
[5]ISANI M A,DELAPLAIN P T,GRISHIN A,et al.Evolving understanding of neonatal necrotizing enterocolitis[J].Curr Opin Pediatr,2018,30(3):417-423.
[6]VONGBHAVIT K,UNDERWOOD M A.Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant[J].Clin Ther,2016,38(4):716-732.
[7]FALLON E M,NEHRA D,POTEMKIN A K,et al.A.S.P.E.N.clinical guidelines:Nutrition support of neonatal patients at risk for necrotizing enterocolitis[J].JPEN J Parenter Enteral Nutr,2012,36(5):506-523.
[8]NATHAN A T,WARD L,SCHIBLER K,et al.A quality improvement initiative to reduce necrotizing enterocolitis across hospital systems[J].J Perinatol,2018,38(6):742-750.
[9]RAJPUT N,FILIPOVSKA J,HEWSON M.The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants[J].Turk J Pediatr,2017,59(1):20-27.
[10]VAN DEN AKKER C H P,VAN GOUDOEVER J B,SZAJEWSKA H,et al.Probiotics for preterm infants:A strainspecific systematic review and network meta-analysis[J].JPediatr Gastroenterol Nutr,2018,67(1):103-122.
[11]林华仙.益生菌联合早期微量喂养预防新生儿坏死性小肠结肠炎效果分析[J].儿科药学杂志,2013,19(6):18-20.
[12]COSTELOE K,BOWLER U,BROCKLEHURST P,et al.Arandomised controlled trial of the probiotic Bifidobacterium breve BBG-001 in preterm babies to prevent sepsis,necrotising enterocolitis and death:The probiotics inpreterm infants(PiPS)trial[J].Health Technol Assess,2016,20(66):1-194.
[13]ALFALEH K,ANABREES J.Probiotics for prevention of necrotizing enterocolitis in preterm infants[J].Cochrane Database Syst Rev,2014,10(4):CD005496.
[14]BLACKWOOD B P,YUAN C Y,WOOD D R,et al.Probiotic lactobacillus species strengthen intestinal barrier function and tight junction integrity in experimental necrotizing enterocolitis[J].J Probiotics Health,2017,5(1):159.
[15]UBEROS J,AGUILERA-RODRíGUEZ E,JEREZ-CALERO A,et al.Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants[J].Br J Nutr,2017,117(7):994-1000.