摘要
背景既往关于口咽初乳对坏死性小肠结肠炎(NEC)发生率影响的文献结论不一。目的系统检索文献,更新Meta分析,探讨口咽初乳能否有效降低NEC发生率。设计系统评价/Meta分析。方法检索英文数据库(PubMed、Embase、Web of Science、Cochrane Library)和中文数据库(中国知网、万方、维普、中华医学期刊全文数据库),检索时间为建库至2025年1月8日。纳入研究对象为胎龄<37周的新生儿(不限制出生体重),试验组采用口咽初乳、初乳涂抹或初乳滴注,对照组采用等量无菌水、生理盐水进行相同操作或常规护理,结局指标包含NEC的中英文RCT文献。由2名研究者独立筛选文献、提取数据,并根据Cochrane系统评价手册6.1提供的偏倚风险评估工具对文献进行偏倚风险评估。主要结局指标NEC(Ⅱ期或以上)发生率。结果27篇RCT(英文18篇,中文9篇)共纳入2950例早产儿,干预组1462例,对照组1488例。口咽初乳的剂量以0.2 mL为主(89%),间隔时间以2~4 h为主(85%),持续时间以3~7 d为主(70%)。Meta分析显示,干预组NECⅡ期或以上的发生率(65/1462)与对照组(147/1488)差异有统计学意义(OR=0.44,95%CI:0.32~0.61,P<0.01),漏斗图分析显示文献发表偏倚不明显。次要结局指标:口咽初乳可降低新生儿败血症(OR=0.55,95%CI:0.42~0.72)、喂养不耐受(OR=0.46,95%CI:0.27~0.78)、新生儿呼吸机相关性肺炎(VAP,OR=0.51,95%CI:0.29~0.92)发生率,缩短达到完全肠内营养时间[-2.50(-4.08~-0.91)d]、住院时间[-4.43(-6.32~-2.54)d]、抗生素使用时间[-2.56(-4.12~-1.01)d]。干预组和对照组的全因死亡率以及脑室内出血(IVH)、慢性肺病(CLD)、早产儿视网膜病变(ROP)发生率差异均无统计学意义。结论口咽初乳可以降低早产儿NEC、新生儿败血症、喂养不耐受、VAP的发生率,缩短早产儿完全肠内营养时间、住院时间及抗生素使用时间。
Background Previous randomized controlled trials(RCTs)and meta-analyses investigating the effect of oropharyngeal colostrum on the incidence of necrotizing enterocolitis(NEC)have reported inconsistent conclusions.Objective To systematically review the literature,update the meta-analysis,and evaluate the efficacy of oropharyngeal colostrum in reducing the incidence of NEC.Design Systematic review/meta-analysis Methods English databases(PubMed,Embase,Web of Science,Cochrane Library)and Chinese databases(CNKI,Wanfang,VIP,Chinese Medical Journal Full-Text Database)were searched from inception to January 8,2025.RCTs in English or Chinese were included if they enrolled neonates with gestational age<37 weeks(regardless of birth weight),compared oropharyngeal colostrum(administered via swabbing,drops,or other methods)with control interventions(sterile water,saline,or routine care),and reported NEC(stage II or above)as an outcome.Two researchers independently screened studies,extracted data,and assessed risk of bias using the Cochrane Risk of Bias Tool(version 6.1).Main outcome measures NEC(stage II or above).Results Twenty-seven RCTs(18 English,9 Chinese)involving 2,950 neonates(intervention:1,462;control:1,488)were included.The majority of studies used 0.2 mL of colostrum(89%),administered every 2-4 hours(85%),for 3-7 days(70%).Meta-analysis using random effects model or fixed-effects model showed a statistically significant reduction in NEC(stageⅡor above)incidence in the intervention group(65/1,462)compared to controls(147/1,488)(OR=0.44,95%CI:0.32-0.61,P<0.01).Funnel plot analysis indicated no significant publication bias.Secondary outcomes:Oropharyngeal colostrum reduced neonatal sepsis(OR=0.55,95%CI:0.42-0.72),feeding intolerance(OR=0.46,95%CI:0.27-0.78),and ventilator-associated pneumonia(VAP)(OR=0.51,95%CI:0.29-0.92).It also shortened time to full enteral feeding(-2.50 d,95%CI:-4.08--0.91),hospital stay(-4.43 d,95%CI:-6.32--2.54),and duration of antibiotic use(-2.56 d,95%CI:-4.12--1.01).No significant differences were observed in all-cause mortality,intraventricular hemorrhage(IVH),chronic lung disease(CLD),or retinopathy of prematurity(ROP).Conclusion Oropharyngeal colostrum reduces the incidence of NEC,neonatal sepsis,VAP,and feeding intolerance in preterm infants,while shortening time to full enteral feeding,hospitalization duration,and antibiotic use.
作者
游森保
杨秋萍
蔡尧
李思涛
YOU Senbao;YANG Qiuping;CAI Yao;LI Sitao(Department of Pediatrics,The Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China;Biomedical Innovation Center,The Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)
出处
《中国循证儿科杂志》
北大核心
2025年第3期211-216,共6页
Chinese Journal of Evidence Based Pediatrics
基金
国家自然科学基金面上项目:82271736
广东省消化系统疾病临床医学研究中心项目:2020B1111170004。
