Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey.
Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey.
J Pediatr. 2015 Mar;166(3):545-51.e1. doi: 10.1016/j.jpeds.2014.12.004. Epub 2015 Jan 13.
To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.
A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2).
The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P < .001). The times to reach full enteral feeding were faster (P < .001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6).
In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.
检验益生菌和益生元（合称为合生元）单独或联合应用（合生元）对极低出生体重（VLBW）儿坏死性小肠结肠炎（NEC）的预防作用。
在土耳其的 5 个新生儿重症监护病房进行了一项前瞻性、随机、对照试验。将 VLBW 婴儿（n=400）分为对照组和 3 个研究组，研究组分别在母乳喂养或配方奶中添加益生菌（长双歧杆菌）、益生元（菊粉）或合生元（长双歧杆菌加菊粉），最大剂量为 8 周，直至出院或死亡。主要结局是 NEC（Bell 分期≥2）。
与益生元组（12.0%）和安慰剂组（18.0%）相比，益生菌组（2.0%）和合生元组（4.0%）的 NEC 发生率较低（P<.001）。达到完全肠内喂养的时间更快（P<.001），临床医院获得性败血症的发生率较低（P=0.004），新生儿重症监护病房的住院时间较短（P=0.002），接受益生菌、益生元或合生元的婴儿死亡率较低（P=0.003）。产前使用类固醇（OR 0.5，95%CI 0.3-0.9）和产后使用益生菌（单独或合生元）（OR 0.5，95%CI 0.2-0.8）降低了 NEC 的风险，而母亲使用抗生素则增加了这一风险（OR 1.9，95%CI 1.1-3.6）。
在 VLBW 婴儿中，益生菌（长双歧杆菌）和合生元（长双歧杆菌加菊粉）而非单独的益生元（菊粉）可降低 NEC 的发生。
