Neonatal Intensive Care Unit, AOU Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy.
Nutrients. 2021 Jan 9;13(1):192. doi: 10.3390/nu13010192.
Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants.
A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed.
Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00-0.21). The subgroup analysis showed that Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01-0.49 vs. OR 0.32; 95% CrIs 0.10-0.36).
Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.
最近的证据支持益生菌在预防早产儿坏死性小肠结肠炎（NEC）中的作用。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对益生菌在预防早产儿 NEC 中的作用进行了系统评价和网络荟萃分析，重点关注不同喂养方式的差异效果。使用随机效应模型；对仅母乳喂养（HM）喂养的婴儿与接受配方奶（单独或与 HM 混合）的婴儿进行了亚组分析。
共纳入 51 项试验（10664 名婴儿，29 项益生菌干预措施）；根据喂养情况，31 项研究（19 种不同的益生菌方案）适合进行亚组分析。在总体分析中，LB 显示出降低 NEC 风险的最有希望的效果（比值比（OR），0.03；95%可信区间（CrI），0.00-0.21）。亚组分析表明，Bb-12/B94 与两种喂养类型人群中 NEC Ⅱ级及以上风险降低相关，在有利于仅 HM 喂养婴儿的相对效应大小上存在差异（OR 0.04；95% CrI <0.01-0.49 与 OR 0.32；95% CrI 0.10-0.36）。
Bb-12/B94 可以根据喂养方式降低 NEC 风险，且效应大小不同。值得注意的是，大多数益生菌菌株在少数试验和相对较小的人群中进行了评估，并非所有 RCT 都有根据喂养类型的结局数据。需要进一步的试验来证实目前的发现。
