Inglis G D T, Jardine L A, Davies M W
Royal Brisbane and Women's Hospital, Grantley Stable Neonatal Unit, Butterfield Street, Herston, Brisbane, Queensland, Australia, 4029.
Cochrane Database Syst Rev. 2007 Jul 18;2007(3):CD004338. doi: 10.1002/14651858.CD004338.pub3.
Intubation is associated with bacterial colonisation of the respiratory tract and, therefore, may increase the risk of acquiring an infection. The infection 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 the acquisition of infection. However, there is the possibility that the harm this may cause might outweigh the benefit.
To assess the effects of prophylactic antibiotics on mortality and morbidity in intubated, ventilated newborn infants who are not known to have infection. In separate comparisons, two different policies regarding the prophylactic use of antibiotics in intubated, ventilated infants were reviewed: 1) among infants who have been intubated for mechanical ventilation, a policy of prophylactic antibiotics for the duration of intubation versus placebo or no treatment 2) among intubated, ventilated infants who have been started on antibiotics at the time of intubation but whose initial cultures to rule out sepsis were negative, a policy of continuing versus discontinuing prophylactic antibiotics.
MEDLINE (January 1950 to March 2007), CINAHL (1982 to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2007), the Cochrane Neonatal Group Specialised Register and reference lists of articles were searched.
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.
Two studies met the criteria for inclusion in this review. One was of insufficient quality to draw any meaningful conclusions. The other was of fair quality and found no significant differences between treatment and control groups in any of the reported outcomes, however, the rates of septicaemia were not reported.
AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to support or refute the use of prophylactic antibiotics when starting mechanical ventilation in newborn infants, or to support or refute continuing antibiotics once initial cultures have ruled out infection in mechanically ventilated newborn infants.
气管插管与呼吸道细菌定植相关，因此可能增加感染风险。感染可能延长机械通气需求并增加慢性肺病风险。为降低定植和感染风险，有人主张对所有机械通气的新生儿使用预防性抗生素。然而，这样做可能造成的危害或许超过益处。
评估预防性抗生素对插管且机械通气、但无感染的新生儿死亡率和发病率的影响。在单独比较中，回顾了关于插管且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，在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）在插管且机械通气、插管时开始使用抗生素但排除败血症的初始培养结果为阴性的婴儿中，继续或停止预防性抗生素治疗的策略。
检索了MEDLINE（1950年1月至2007年3月）、CINAHL（1982年至2007年3月）、Cochrane对照试验中心注册库（Cochrane图书馆，2007年第1期）、Cochrane新生儿组专业注册库以及文章的参考文献列表。
质量足够的随机对照试验，其中机械通气的新生儿被随机分配接受预防性抗生素与安慰剂或不治疗。
两名评价员独立评估试验质量。
两项研究符合本综述的纳入标准。一项质量不足以得出任何有意义的结论。另一项质量尚可，在任何报告的结局中，治疗组和对照组之间均未发现显著差异，然而，未报告败血症发生率。
随机试验中没有足够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，也没有足够证据支持或反驳在机械通气的新生儿初始培养排除感染后继续使用抗生素。
