Inglis G D, Davies M W
Grantley Stable Neonatal Unit, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia.
Cochrane Database Syst Rev. 2004(1):CD004338. doi: 10.1002/14651858.CD004338.pub2.
Bacterial colonisation of the respiratory tract is associated with intubation and may increase the risk of acquiring infection. This may prolong the need for mechanical ventilation and increase the risk of chronic lung disease. The use of prophylactic antibiotics has been advocated for all mechanically ventilated newborns in order to reduce the risk of colonisation and acquired infection. Countering this is the possibility that harm may outweigh benefit.
To assess the effects of prophylactic antibiotics in reducing mortality and morbidity in intubated and ventilated newborn infants who are not known to have infection. In separate comparisons, we reviewed two different policies regarding the prophylactic use of antibiotics in intubated, ventilated infants: 1) among babies who are being intubated for mechanical ventilation, a policy of prophylactic antibiotics for the duration of intubation versus placebo or no treatment. 2) among intubated, ventilated babies who had been started on antibiotics at the time of intubation but whose initial cultures to rule our sepsis are negative, a policy of continuing versus discontinuing prophylactic antibiotics.
We searched MEDLINE (January 1966 to May 2003), CINAHL (1982 to May 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), the Cochrane Neonatal Group Specialised Register and reference lists of articles.
Randomised controlled trials of sufficient quality in which mechanically ventilated newborn infants are randomised to receive prophylactic antibiotics versus placebo or no treatment.
Two reviewers independently assessed trial quality.
One study, of insufficient quality, met the criteria for inclusion in this review.
REVIEWER'S CONCLUSIONS: There is no evidence from randomised trials to support or refute the use of prophylactic antibiotics when commencing mechanical ventilation in newborn infants, or to support or refute continuing antibiotics once initial cultures rule out infection in mechanically ventilated newborn infants.
呼吸道细菌定植与插管相关，可能增加感染风险。这可能延长机械通气需求并增加慢性肺病风险。为降低定植和获得性感染风险，已提倡对所有机械通气新生儿使用预防性抗生素。但也存在危害可能超过益处的可能性。
评估预防性抗生素对降低未知有感染的插管及机械通气新生儿死亡率和发病率的影响。在单独比较中，我们回顾了关于插管、机械通气婴儿预防性使用抗生素的两种不同策略：1）在因机械通气而插管的婴儿中，插管期间使用预防性抗生素与使用安慰剂或不治疗的策略。2）在插管时已开始使用抗生素但排除败血症的初始培养结果为阴性的插管、机械通气婴儿中，继续或停止预防性抗生素使用的策略。
我们检索了MEDLINE（1966年1月至2003年5月）、CINAHL（1982年至2003年5月）、Cochrane对照试验中央注册库（Cochrane图书馆，2003年第1期）、Cochrane新生儿组专业注册库及文章参考文献列表。
质量足够的随机对照试验，其中机械通气新生儿被随机分配接受预防性抗生素、安慰剂或不治疗。
两名评价员独立评估试验质量。
一项质量不足的研究符合纳入本综述的标准。
随机试验中没有证据支持或反驳在新生儿开始机械通气时使用预防性抗生素，也没有证据支持或反驳在机械通气新生儿初始培养排除感染后继续使用抗生素。
