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Enteral antibiotics for preventing necrotising enterocolitis in low birthweight or preterm infants
1Neonatal Services, Royal Hobart Hospital, Liverpool St., Hobart, Tasmania, Australia, 7000. graham.bury@dchs.tas.gov.au
Insights
Prophylactic enteral antibiotics significantly reduced necrotising enterocolitis (NEC) in preterm infants but increased resistant bacteria. More research is needed to confirm benefits and harms before clinical use.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Necrotising enterocolitis (NEC) poses a significant risk to preterm neonates.
- Enteral antibiotics have been investigated as a potential prophylactic measure against NEC.
Purpose of the Study:
- To systematically review the benefits and harms of using enteral antibiotic prophylaxis for NEC in low birth weight and preterm infants.
Main Methods:
- Systematic review and meta-analysis of randomized or quasi-randomized controlled trials.
- Searches included major databases and grey literature.
- Data extraction and quality assessment followed Cochrane Collaboration guidelines.
Main Results:
- Enteral antibiotic prophylaxis significantly reduced NEC incidence (RR 0.47).
- A borderline significant reduction in NEC-related deaths was observed (RR 0.16).
- A significant increase in colonization with resistant bacteria was noted (RR 1.73).
Conclusions:
- Current evidence is insufficient to recommend enteral antibiotic prophylaxis for NEC in clinical practice.
- Larger trials are required to fully evaluate benefits and harms, especially concerning resistant bacteria.
- Adverse outcomes, including infections from resistant organisms, warrant careful consideration.
Background:
Necrotising enterocolitis continues to be a problem, particularly in preterm neonates. There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis. This systematic review was undertaken to clarify the issue.
Objectives:
To evaluate the benefits and harms of enteral antibiotic prophylaxis for necrotising enterocolitis in low birth weight and preterm infants.
Search Strategy:
Searches were made of the Oxford Database of Perinatal trials, MEDLINE (search terms: necrotizing enterocolitis, antibiotics;
Limits:
newborn infant), previous reviews with cross references, abstracts, conference and symposia proceedings, expert informants and journal handsearching in the fields of Neonatal Pediatrics and Microbiology.
Selection Criteria:
All randomized or quasi-randomized controlled trials where enteral antibiotics were used as prophylaxis against NEC in LBW (<2500g) and/or preterm (<37 weeks gestation) infants.
Data Collection And Analysis:
The standard method of the Cochrane Collaboration and its Neonatal Review Group was used. The methodological quality of each trial was reviewed by the second author who was blinded to the trial authors and institutions. Each author extracted data separately before comparison and resolution of differences. Relative risk (RR), risk difference (RD), and number needed to treat were used in the analysis.
Main Results:
The administration of prophylactic enteral antibiotics resulted in a statistically significant reduction in NEC [RR 0.47 (0.23, 0.98); RD -0.072 (-0.136, -0.008); NNT 13.9 (7.4, 125)]. There was a reduction in NEC-related deaths which was of borderline statistical significance [RR 0.16 (0.02, 1.26); RD -0.097 (-0.183, -0.010); NNT 10.3 (5.46, 100)]. There were no significant differences in all deaths (one trial only) or in NEC-like enteropathies (one trial only). There was a statistically significant increase in the incidence of colonisation with resistant bacteria [RR 1.73 (1.00, 2. 97); RD 0.123 (0.008, 0.238); NNT 8.1 (4.2, 125)].
Reviewer'S Conclusions:
There is insufficient evidence to support the use of enteral antibiotic prophylaxis for NEC in clinical practice. To address this question further, a large trial would be required with a sample size sufficient to examine all the important benefits and harms. Adverse outcomes associated with infection, particularly with resistant bacteria, should be evaluated.