Meyer Michael P, Alexander Tanith
Neonatal Unit Kidz First Paediatrics, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
Department of Paediatrics, University of Auckland, Grafton Auckland, New Zealand.
J Neonatal Perinatal Med. 2017;10(3):249-255. doi: 10.3233/NPM-16130.
Preterm infants remain at high risk of adverse outcomes following necrotizing enterocolitis (NEC) and late onset sepsis (LOS). Meta-analysis of randomized trials has indicated a reduction in severe NEC following use of probiotics and bovine lactoferrin (LF). Overall, however, uncertainty remains over which probiotic, or combination to use. The aim of this study was to compare the incidence of severe NEC and LOS before and after routine supplementation with Lactobacillus GG (LGG) and LF.
In this retrospective cohort study, infants <32 weeks or <1500 g routinely received LGG and 100 mg lactoferrin daily from 2011 -2015 were compared with similar infants born from 2004-2008. Cases of NEC were Bell stage 2 or greater and LOS was blood or spinal fluid culture positive after 48 hrs of age.
We noted a marked decline in the incidence of NEC from 3% to 1% with a RR of 0.29 (CI 0.1-0.9) and a number needed to benefit of 50. The cost of preventing one case of NEC was estimated to be NZ $2800, considerably lower than the cost of treatment. LOS rates were not significantly different. There was a decrease in retinopathy treatment rates. During the period there was one case of LGG sepsis in a 23 week gestation infant with abdominal pathology and one infant developed NEC after stopping prophylaxis.
The rates of severe NEC was markedly reduced following prophylaxis. The case of LGG sepsis indicates caution is required in extremely preterm infants.
坏死性小肠结肠炎（NEC）和晚发性败血症（LOS）后，早产儿仍面临不良结局的高风险。随机试验的荟萃分析表明，使用益生菌和牛乳铁蛋白（LF）后严重NEC有所减少。然而，总体而言，使用哪种益生菌或组合仍存在不确定性。本研究的目的是比较常规补充鼠李糖乳杆菌GG（LGG）和LF前后严重NEC和LOS的发生率。
在这项回顾性队列研究中，将2011 - 2015年期间常规每日接受LGG和100毫克乳铁蛋白的孕周<32周或出生体重<1500克的婴儿与2004 - 2008年出生的类似婴儿进行比较。NEC病例为Bell 2期或更严重，LOS为48小时龄后血培养或脑脊液培养阳性。
我们注意到NEC的发生率从3%显著下降到1%，相对危险度为0.29（可信区间0.1 - 0.9），需治疗获益人数为50。预防一例NEC的成本估计为2800新西兰元，远低于治疗成本。LOS发生率无显著差异。视网膜病变治疗率有所下降。在此期间，一名孕23周有腹部病变的婴儿发生了LGG败血症，一名婴儿在停止预防后发生了NEC。
预防后严重NEC的发生率显著降低。LGG败血症病例表明，对极早产儿需要谨慎。
