Supplementation With Probiotics Prevent Necrotizing Enterocolitis In Very Low Birth Weight Preterm Infants:a Systematic Review

Objective:To evaluate the benefits and safety of probiotics supplement for preterm very-low-birth-weight infants severe necrotizing enterocolitis (NEC).Methods:We searched in Cochrane database, EMBASE, PubMed,Wanfang Chinese periodical database, VIP Chinese Scientific Journals Database, CNKI databases and the Chinese Biomedical Literature database.The RevMan5.2software was used for the Meta-analysis of all inclusion literature.The main outcome was the incidence of severe NEC, total mortality, mortality related to NEC, and incidence of sepsis.The secondary outcome was days of parenteral nutrition, days to achieve full enteral nutrition, duration (days) of hospitalization, duration (days), hospitalization in NICU, the proportion of use antibiotic, days of use antibiotics, incidence of feeding intolerance, severe intraventricular hemorrhage(Ⅲdegree and above)morbidity.Results:A total of195documents were retrieved,18RCTs fulfilled the inclusion criteria. There were some difference at the basic situation between all relevant studies such as birth gestational age, birth weight are some differences, the type of application of probiotics, the dose, the use of time, and etc. Meta-analysis results showed that probiotic supplements can effectively reduce the incidence of preterm low birth weight children severe NEC and total mortality, OR values were0.31(95%CI:0.22～0.44), P<0.00001), and0.51(95%CI:0.39～0.66, P <0.00001), reduce days to achieve full enteral nutrition and delay the onset of severe NEC, MD values were-2.69(95%CI:-4.54～0.85, P=0.004) and5.86(95%CI:0.50～10.26, P=0.03). No evidence that probiotic supplements can effectively reduce NEC related mortality and incidence of sepsis of preterm low-birth-weight infant, OR values were0.69(95%CI:0.40-1.19, P=0.18) and0.83(95%CI:0.60～1.12, P=0.22). There were no significant impact for supplemental probiotics at duration (days) of hospitalization,duration (days), hospitalization in NICU, the proportion of use antibiotic, days of use antibiotics, incidence of feeding intolerance severe intraventricular hemorrhage(III degree and above)morbidity. Conclusion:Probiotic supplements can effectively reduce risk of NEC and total mortality in preterm very-low-birth-weight infants, can effectively reduce the incidence of feeding intolerance, can earlier achieve full enteral feeding. This analysis support supply probiotic for preterm very-low-birth-weight infant. However,the optimum type of probiotic and long-term effects of probiotic need further study.