Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants

Bury, R. G. and Tudehope, D. (2001) Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. Cochrane Database of Systematic Reviews, 1: 1-18. doi:10.1002/14651858.CD000405


Author Bury, R. G.
Tudehope, D.
Title Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants
Journal name Cochrane Database of Systematic Reviews
ISSN 1464-780X
Publication date 2001
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD000405
Issue 1
Start page 1
End page 18
Total pages 18
Publisher Cochrane Collaboration
Collection year 2000
Language eng
Subject C3
730204 Child health
111403 Paediatrics
Formatted abstract
Background
Necrotizing enterocolitis (NEC) is the most common gastrointestinal problem of 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, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2006), MEDLINE (1966 - July 2006), EMBASE (1988 - July 2006) and CINAHL (1982 - July 2006) 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 (< 2500 g) 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 [typical RR 0.47 (0.28, 0.78); typical RD -0.10 (-0.16, -0.04); NNT 10 (6, 25)].

There was a statistically significant reduction in NEC-related deaths [typical RR 0.32 (0.10, 0.96); typical 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 [typical 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)].

Authors' 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
Keyword Anti-Bacterial Agents - administration & dosage
Enterocolitis, Necrotizing - prevention & control
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature Diseases - prevention & control
Randomized Controlled Trials as Topic
Anti-Bacterial Agents - therapeutic use
Q-Index Code C3
Additional Notes Intervention review. Art. no. CD000405 - This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). This record should be cited as: Bury RG, Tudehope D. Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000405. DOI: 10.1002/14651858.CD000405. This version first published online: April 27. 1998 Last assessed as up-to-date: August 31. 2006

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Tue, 10 Jun 2008, 13:22:04 EST