Monash Newborn, Monash Children's Hospital, Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia.
Division of Neonatology, Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
J Perinat Med. 2022 Oct 31;51(3):403-422. doi: 10.1515/jpm-2022-0131. Print 2023 Mar 28.
Neonatal sepsis is one of the leading causes of neonatal deaths in neonatal intensive care units. Hence, it is essential to review the evidence from systematic reviews on interventions for reducing late-onset sepsis (LOS) in neonates.
PubMed and the Cochrane Central were searched from inception through August 2020 without any language restriction. Cochrane reviews of randomized clinical trials (RCTs) assessing any intervention in the neonatal period and including one or more RCTs reporting LOS. Two authors independently performed screening, data extraction, assessed the quality of evidence using Cochrane Grading of Recommendations Assessment, Development and Evaluation, and assessed the quality of reviews using a measurement tool to assess of multiple systematic reviews 2 tool.
A total of 101 high-quality Cochrane reviews involving 612 RCTs and 193,713 neonates, evaluating 141 interventions were included. High-quality evidence showed a reduction in any or culture-proven LOS using antibiotic lock therapy for neonates with central venous catheters (CVC). Moderate-quality evidence showed a decrease in any LOS with antibiotic prophylaxis or vancomycin prophylaxis for neonates with CVC, chlorhexidine for skin or cord care, and kangaroo care for low birth weight babies. Similarly, moderate-quality evidence showed reduced culture-proven LOS with intravenous immunoglobulin prophylaxis for preterm infants and probiotic supplementation for very low birth weight (VLBW) infants. Lastly, moderate-quality evidence showed a reduction in fungal LOS with the use of systemic antifungal prophylaxis in VLBW infants.
The overview summarizes the evidence from the Cochrane reviews assessing interventions for reducing LOS in neonates, and can be utilized by clinicians, researchers, policymakers, and consumers for decision-making and translating evidence into clinical practice.
新生儿败血症是新生儿重症监护病房新生儿死亡的主要原因之一。因此，有必要对降低新生儿晚发型败血症（LOS）的系统评价中的干预措施进行证据回顾。
从建库至 2020 年 8 月，我们对 PubMed 和 Cochrane 中心进行了检索，不限制语言。我们纳入了评估新生儿期任何干预措施的 Cochrane 随机对照试验（RCT）的综述，且这些综述至少包含 1 项报告 LOS 的 RCT。两名作者独立进行筛选、数据提取，使用 Cochrane 推荐评估、制定与评价分级工具评估证据质量，并使用评估多项系统评价工具评估综述质量。
共纳入 101 项高质量 Cochrane 综述，涉及 612 项 RCT 和 193713 例新生儿，评估了 141 项干预措施。高质量证据表明，对于有中心静脉导管（CVC）的新生儿，使用抗生素锁疗法可降低任何或培养证实的 LOS。中等质量证据表明，对于有 CVC 的新生儿使用抗生素预防或万古霉素预防、氯己定皮肤或脐带护理、袋鼠式护理，可降低任何 LOS。同样，对于早产儿，使用静脉注射免疫球蛋白预防和极低出生体重儿（VLBW）补充益生菌也可降低培养证实的 LOS。最后，中等质量证据表明，对于 VLBW 婴儿，使用全身性抗真菌预防可降低真菌性 LOS。
该综述总结了评估降低新生儿 LOS 的 Cochrane 综述中的证据，可被临床医生、研究人员、政策制定者和消费者用于决策，并将证据转化为临床实践。
