Bury R G, Tudehope D
Neonatal Services, Royal Hobart Hospital, Liverpool St., Hobart, Tasmania, AUSTRALIA, 7000.
Cochrane Database Syst Rev. 2001(1):CD000405. doi: 10.1002/14651858.CD000405.
Necrotizing enterocolitis continues to be a problem, particularly in 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.
To evaluate the benefits and harms of enteral antibiotic prophylaxis for necrotizing enterocolitis in low birth weight and preterm infants.
Searches were made of the Oxford Database of Perinatal trials, MEDLINE (1966 - June 2000; search terms: necrotizing enterocolitis, antibiotics; limits: newborn infant), previous reviews with cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the fields of neonatal pediatrics and microbiology.
All randomized or quasi-randomized controlled trials where enteral antibiotics were used as prophylaxis against NEC in LBW (<2500g) and/or preterm (<37 weeks gestation) infants.
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.
Five eligible trials involving 456 infants were included. The administration of prophylactic enteral antibiotics resulted in a statistically significant reduction in NEC [RR 0.47 (0.28, 0.78); RD -0.10 (-0.16, -0.04); NNT 10 (6, 25)]. There was a statistically significant reduction in NEC-related deaths [RR 0.32 (0.10, 0.96); 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 [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)].
REVIEWER'S 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
坏死性小肠结肠炎仍然是一个问题，尤其是在早产儿中。有报告表明，使用肠内抗生素作为预防措施可能有效。进行这项系统评价以阐明该问题。
评估肠内抗生素预防低体重和早产儿坏死性小肠结肠炎的益处和危害。
检索了牛津围产期试验数据库、MEDLINE（1966年至2000年6月；检索词：坏死性小肠结肠炎、抗生素；限定：新生儿）、以前带有交叉参考文献的综述、摘要、会议和研讨会论文集、专家提供的信息以及新生儿儿科学和微生物学领域的期刊手工检索。
所有将肠内抗生素用作预防低体重（<2500g）和/或早产（<37周妊娠）婴儿坏死性小肠结肠炎的随机或半随机对照试验。
采用Cochrane协作网及其新生儿综述组的标准方法。每项试验的方法学质量由对试验作者和机构不知情的第二作者进行审查。每位作者在比较和解决差异之前分别提取数据。分析中使用相对风险（RR）、风险差异（RD）和需治疗人数。
纳入了五项符合条件的试验，涉及456名婴儿。预防性使用肠内抗生素使坏死性小肠结肠炎的发生率有统计学意义的降低[RR 0.47（0.28，0.78）；RD -0.10（-0.16，-0.04）；NNT 10（6，25）]。坏死性小肠结肠炎相关死亡有统计学意义地减少[RR 0.32（0.10，0.96）；RD -0.07（-0.13，0.01）；NNT 14（8，100）]。所有死亡有减少趋势但无统计学意义[RR 0.67（0.34，1.32）]。坏死性小肠结肠炎样肠病无显著差异（仅一项试验）。一项研究发现耐药菌定植发生率有统计学意义地增加，三项试验的汇总分析显示增加幅度刚具有显著性[RR 1.73（1.00，2.97）；RD 0.07（0.00，0.13）]。
有证据表明口服抗生素可降低低体重婴儿坏死性小肠结肠炎的发生率。然而，对不良后果的担忧仍然存在，尤其是与耐药菌的产生有关。为进一步解决这个问题，需要进行一项样本量足够大的试验，以检验所有重要的益处和危害。应评估与感染相关的不良后果，并开展寻找耐药菌产生情况的微生物学研究。
