Strategy to Prevent the Necrotizing Enterocolitis - Medical Science Assignment Help

Assignment Task;

Task:

Which is the best probiotic treatment strategy to prevent the necrotizing enterocolitis in premature infants

A network meta-analysis revealing the efficacy and safety

Abstract Background: Previous studies have neglected to report the specific action of different probiotic genera in preterm infants. To evaluate the efficacy and safety of specific probiotic genera, we performed a network meta-analysis (NMA) to identify the best prevention strategy for necrotizing enterocolitis in preterm infants.

Methods: MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials had been searched for randomized control trials reporting the probiotics strategy for premature infants.

Results: We identified 34 eligible studies of 9161 participants. The intervention in the observation group was to add probiotics for feeding: Lactobacilli in 6 studies; Bifidobacterium in 8 studies; Bacillus in 1 study; Saccharomyces in 4 studies and probiotic mixture in 15 studies. This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants. A probiotic mixture showed effectiveness in reducing mortality in preterm infants.

Conclusion: The recent literature has reported a total of 5 probiotic strategies, including Bacillus, Bifidobacterium, Lactobacillus, Saccharomyces, and probiotic mixture. Our thorough review and NMA provided a piece of available evidence to choose optimal probiotics prophylactic strategy for premature infants. The results indicated that probiotic mixture and Bifidobacterium showed a stronger advantage to use in preterm infants; the other probiotic genera failed to show an obvious effect to reduce the incidence of NEC, sepsis and all-cause death. More trials need to be performed to determine the optimal probiotic treatment strategy to prevent preterm related complications.

Abbreviations: CIs = confidence intervals, MD = mean difference, NEC = Necrotizing enterocolitis, NICU = neonatal intensive care unit, NMA = network meta-analysis, OR = odds ratios, PRISMA = the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, RCT = randomized controlled trial, SUCRA = Surface under the cumulative ranking curve.

Keywords: necrotizing enterocolitis, preterm infants, probiotics, sepsis

Introduction

Necrotizing enterocolitis (NEC) is one of the most common and serious preterm-related complications with high surgical rate and mortality in premature infants. The morbidity of NEC can be as high as 28% in very low birthweight infants.[1,2] Besides that, although accept medical treatment, patients with NEC tend to suffer from long-term complications which included chronic nutritional intolerance, short bowel syndrome, and growth retardation.[3] Therefore, the prevention of the incidence of NEC seems to be more important and effective than its treatment. Some studies reported that key risk factors for NEC include an overgrowth of pathogenic microflora in premature infants, primarily because of the immature mucosal barrier and immune response in preterm newborns, together with their exposure highrisk hospital milieu with bacterial pathogens.[4–6] Recently, the probiotic product has been reported to be beneficial for decreasing the morbidity of NEC in the literature. Probiotics, as live microbial supplements, might to improve the function of the intestinal mucosal barrier and competitively inhibit the growth of gastrointestinal pathogenic bacteria in preterm infants.[7,

Materials and methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and reported a net-meta analysis of the RCTs. 2.1.

Literature searches

Two independent reviewers systematically searched the following electronic databases: PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify literature on probiotics for NEC in premature infants before January 2019. We used PubMed medical subject heading terms and free-text words in combination with Boolean operators as comprehensively as possible: (premature birth OR preterm birth OR preterm infants) AND (RCT OR controlled clinical trial OR randomly) AND (probiotics OR probiotic treatment). Besides, we further searched other databases (EBSCO Information Services, Web of Science, and Google Scholars) to identify potentially available studies. The process was completed when no further trials could be determined. The review was limited to RCTs. The ethical approval is not necessary

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