Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia.
BMC Med. 2011 Aug 2;9:92. doi: 10.1186/1741-7015-9-92.
Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates.
To develop evidence-based guidelines for probiotic supplementation in preterm neonates.
To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review.
In this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research.
We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics.
目前的证据表明，益生菌补充剂可显著降低早产儿的全因死亡率和明确的坏死性小肠结肠炎，且无明显不良反应。随着关于益生菌常规补充的利弊的争论不断，许多机构对当前的证据感到满意，并希望常规使用益生菌。由于缺乏益生菌补充的许多实际方面的详细信息，迫切需要制定便于临床医生使用的指南，以优化早产儿中益生菌的使用。
制定早产儿益生菌补充的循证指南。
为制定益生菌使用的核心指南，包括菌株选择、补充剂量和持续时间，我们主要使用了我们最近更新的随机对照试验系统评价中的数据。对于同样重要的问题，包括菌株鉴定、不良反应监测、产品形式、储存和运输以及监管障碍，我们进行了全面的文献检索，涵盖了 1966 年至 2010 年的时期，研究设计不受限制，使用了 PubMed 和 EMBASE 数据库以及科学会议的会议记录；这些数据用于我们的更新系统评价。
在本次综述中，我们提出了包括证据水平在内的指南，涵盖了益生菌补充的实际方面（例如，菌株选择、剂量、持续时间、临床和实验室监测），以及处理非临床但重要的问题（例如，监管要求、产品形式）。在某些领域证据不足，这些领域应成为进一步研究的目标。
我们希望这些基于证据的指南将有助于优化早产儿中益生菌的使用。继续研究对于提供关于益生菌的当前知识空白的答案至关重要。
