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Chinese Journal of Evidence -Based Pediatric ›› 2016, Vol. 11 ›› Issue (6): 401-409.

• Original Papers •     Next Articles

Prophylactic probiotics for preventing necrotizing enterocolitis in preterm neonates: a systematic review and meta-analysis

GUO Ming1, 4, TANG Xiao-yu2, 3, 4, YE Yuan2, 3, NIU Jia-lan2, 3, KOU Cheng-kun2, 3, MA Bin2, 3, ZHANG Xue-feng1   

  1. 1 Department of Neonatology, 302 Military Hospital of China, Beijing 100039, China;2 Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China;3 Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China;4 Co-first author
  • Received:2016-10-13 Revised:2016-12-06 Online:2016-12-25 Published:2016-12-25
  • Contact: ZHANG Xue-feng

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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 (stage Ⅲ), 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 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 didn't 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.