Related Experiment Videos
Enteral antibiotics for preventing necrotizing 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 reduce necrotizing enterocolitis (NEC) and related deaths in preterm infants. However, concerns about increased resistant bacteria warrant further investigation in large trials.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Infectious Diseases
Background:
- Necrotizing enterocolitis (NEC) remains a significant concern for preterm neonates.
- Enteral antibiotic prophylaxis has been proposed as a strategy to reduce NEC incidence.
- This systematic review aims to clarify the efficacy and safety of this intervention.
Purpose of the Study:
- To evaluate the benefits and harms of using enteral antibiotics for NEC prophylaxis.
- Focus on low birth weight (LBW) and preterm infants.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searches included major databases (MEDLINE, Oxford Database of Perinatal trials) and other sources.
- Data analysis included relative risk (RR), risk difference (RD), and number needed to treat (NNT).
Main Results:
- Five trials involving 456 infants were included.
- Enteral antibiotics significantly reduced NEC incidence (RR 0.47) and NEC-related deaths (RR 0.32).
- A significant increase in resistant bacteria colonization was observed (RR 1.73).
Conclusions:
- Oral antibiotics show promise in reducing NEC in LBW infants.
- Concerns regarding adverse outcomes, especially the development of resistant bacteria, persist.
- Larger trials are needed to fully assess benefits and harms, including microbiological surveillance.
Background:
Necrotizing 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 necrotizing enterocolitis in low birth weight and preterm infants.
Search Strategy:
Searches were made of the Oxford Database of Perinatal trials, MEDLINE (1966 - June 2000; search terms: necrotizing enterocolitis, antibiotics; limits: newborn infant), previous reviews with cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching 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:
Five eligible trials involving 456 infants were included. The administration of prophylactic enteral antibiotics resulted in a statistically significant reduction in NEC [RR 0.47 (0.28, 0.78); RD -0.10 (-0.16, -0.04); NNT 10 (6, 25)]. There was a statistically significant reduction in NEC-related deaths [RR 0.32 (0.10, 0.96); RD -0.07 (-0.13, 0.01); NNT 14 (8, 100)]. There was a trend towards a reduction in all deaths which was not significant [RR 0.67(0.34, 1.32)]. There were no significant differences in NEC-like enteropathies (one trial only). One study found a statistically significant increase in the incidence of colonization with resistant bacteria and the summary analysis of three trials gave an increase which was just significant [RR 1.73 (1.00, 2.97); RD 0.07 (0.00, 0.13)].
Reviewer'S Conclusions:
Evidence suggests that oral antibiotics reduce the incidence of NEC in low birth weight infants. However concerns about adverse outcomes persist, particularly related to the development of resistant bacteria. 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 should be evaluated, and microbiological studies looking for the development of resistant bacteria should be undertaken