常规益生菌（鼠李糖乳杆菌 DSM 17938）使用对出生体重<1000 克的新生儿坏死性小肠结肠炎发生率的影响：一项序贯分析。
Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight < 1000 grams: a sequential analysis.
机构信息
Women's Hospital of Greensboro, Cone Health, Greensboro, NC, USA.
出版信息
BMC Pediatr. 2012 Sep 4;12:142. doi: 10.1186/1471-2431-12-142.
BACKGROUND
Necrotizing enterocolitis (NEC) is a disease in neonates, often resulting in death or serious medical or neurodevelopmental complications. The rate of NEC is highest in the smallest babies and many efforts have been tried to reduce the rate of NEC. In neonates born below 1500 grams, the rate of NEC has been significantly reduced with the use of various probiotics. This study examines the impact of routine use of a probiotic, Lactobacillus reuteri DSM 17938 (BioGaia®), on the rate of NEC in neonates at highest risk for developing NEC, those with birth weight ≤1000 grams.
METHODS
This is a retrospective cohort study comparing the rates of NEC in neonates with birth weight ≤ 1000 grams. The groups are separated into those neonates born from January 2004 to June 30, 2009, before introduction of L. reuteri , and neonates born July 2009 through April 2011 who received routine L. reuteri prophylaxis. The chart review study was approved by our institutional review board and exempted from informed consent.Neonates were excluded if they died or were transferred within the first week of life. The remainder were categorized as having no NEC, medical NEC, surgical NEC, or NEC associated death. Since no major changes occurred in our NICU practice in recent years, and the introduction of L. reuteri as routine prophylaxis was abrupt, we attributed the post-probiotic changes to the introduction of this new therapy. Rates of NEC were compared using Chi square analysis with Fisher exact t-test.
RESULTS
Medical records for 311 neonates were reviewed, 232 before- and 79 after-introduction of L. reuteri prophylaxis. The incidence of NEC was significantly lower in the neonates who received L. reuteri (2 of 79 neonates [2.5%] versus 35 of 232 untreated neonates [15.1%]). Rates of late-onset gram-negative or fungal infections (22.8 versus 31%) were not statistically different between treated and untreated groups. No adverse events related to use of L reuteri were noted.
CONCLUSIONS
Prophylactic initiation of L. reuteri as a probiotic for prevention of necrotizing enterocolitis resulted in a statistically significant benefit, with avoidance of 1 NEC case for every 8 patients given prophylaxis.
背景
坏死性小肠结肠炎（NEC）是一种新生儿疾病，常导致死亡或严重的医疗或神经发育并发症。在最小的婴儿中，NEC 的发病率最高，为此已经尝试了许多方法来降低 NEC 的发病率。在出生体重低于 1500 克的新生儿中，使用各种益生菌可显著降低 NEC 的发病率。本研究探讨了常规使用益生菌罗伊氏乳杆菌 DSM 17938（BioGaia®）对出生体重≤1000 克的 NEC 高危新生儿 NEC 发病率的影响。
方法
这是一项回顾性队列研究，比较了出生体重≤1000 克的新生儿 NEC 发病率。将两组新生儿分为 2004 年 1 月至 2009 年 6 月 30 日出生的罗伊氏乳杆菌使用前组和 2009 年 7 月至 2011 年 4 月出生的常规使用罗伊氏乳杆菌预防组。该病例研究已获得我们机构审查委员会的批准，并豁免了知情同意。如果新生儿在生命的第一周内死亡或转院，则将其排除在外。其余新生儿被归类为无 NEC、医学 NEC、手术 NEC 或 NEC 相关死亡。由于近年来我们的新生儿重症监护病房实践中没有发生重大变化，并且罗伊氏乳杆菌的引入是突然的常规预防措施，因此我们将益生菌治疗后的变化归因于这种新疗法的引入。使用卡方分析和 Fisher 精确检验比较 NEC 发生率。
结果
共回顾了 311 名新生儿的病历，其中罗伊氏乳杆菌预防使用前 232 名，预防使用后 79 名。接受罗伊氏乳杆菌治疗的新生儿 NEC 发病率明显较低（79 名新生儿中有 2 例[2.5%]，232 名未治疗新生儿中有 35 例[15.1%]）。治疗组和未治疗组晚发性革兰氏阴性或真菌感染的发生率（22.8%对 31%）无统计学差异。未发现与使用 L 罗伊氏乳杆菌相关的不良事件。
结论
预防性使用罗伊氏乳杆菌作为益生菌预防坏死性小肠结肠炎可显著获益，每预防 8 例患儿发生 1 例 NEC。
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