双歧杆菌三联活菌胶囊/散防治新生儿喂养不耐受临床疗效的Meta分析

Clinical Efficacy of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules/Powder in the Prevention and Treatment of Neonatal Feeding Intolerance:A Meta-Analysis

目的为新生儿喂养不耐受的临床防治提供参考。方法采用计算机检索中国知网、万方、维普、中国生物医学文献及PubMed,Embase,The Cochrane Library,Web of Science数据库中双歧杆菌三联活菌胶囊/散防治新生儿喂养不耐受的随机对照试验(RCT),检索时限为自建库起至2022年6月15日,由2名研究者独立筛选文献,并提取相关数据,采用RevMan 5.3软件进行Meta分析,二分类变量以比值比(OR)和95%置信区间(95%CI)表示,连续性变量以加权均数差(MD)和95%CI表示。通过Q检验和I2检验进行异质性检验,通过Stata 15.1软件进行Egger检验判断是否存在发表偏倚。结果共纳入23项RCT,涉及1803例新生儿。其中,预防性研究14项(1007例),治疗性研究9项(796例)。Meta分析结果显示,预防性使用双歧杆菌三联活菌胶囊/散可显著降低新生儿喂养不耐受的发生率[OR=0.29,95%CI(0.21,0.41),P<0.00001],显著缩短患儿的达全肠道喂养时间[MD=-2.49,95%CI(-3.33,-1.64),P<0.00001],恢复出生体质量时间[MD=-2.11,95%CI(-2.57,-1.66),P<0.00001],住院时间[MD=-4.62,95%CI(-5.69,-3.54),P<0.00001],但坏死性结肠炎发生率组间无显著差异[OR=0.23,95%CI(0.05,1.10),P=0.07];治疗性使用双歧杆菌三联活菌胶囊/散可显著提高治疗有效率[OR=5.15,95%CI(2.74,9.68),P<0.00001],显著缩短患儿的达全肠道喂养时间[MD=-5.18,95%CI(-7.20,-3.16),P<0.00001],恢复出生体质量时间[MD=-3.99,95%CI(-4.41,-3.57),P<0.00001],住院时间[MD=-4.01,95%CI(-6.09,-1.92),P=0.0002]。结论服用双歧杆菌三联活菌胶囊/散可有效预防或治疗新生儿喂养不耐受,缩短达全肠道喂养时间和住院时间,促进生长发育。

Objective To provide a reference for the clinical prevention and treatment of neonatal feeding intolerance(FI).Methods Randomized controlled trials(RCTs)of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules/Powder in the prevention and treatment of neonatal FI in the CNKI,Wanfang,VIP,CBM,PubMed,Embase,The Cochrane Library,Web of Science database were searched from the inception of the database to June 15,2022,and the studies were independently screened by two researchers.Relevant data were extracted and Meta-analysis was performed by the RevMan 5.3.0 software.The binary variables were represented by odd ratio(OR)and 95%confidence interval(95%CI),while the continuous variables were represented by weighted mean difference(MD)and 95%CI.Heterogeneity test was conducted through the Q test and I 2 test,and the Egger test was performed by the Stata 15.1 software to determine whether there was a publication bias.Results A total of 23 RCTs with 1803 neonates were enrolled,including fourteen preventive studies(1007 cases)and nine therapeutic studies(796 cases).The Meta-analysis results showed that prophylactic use of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules/Powder could significantly reduce the incidence of neonatal FI[OR=0.29,95%CI(0.21,0.41),P<0.00001],significantly shorten the time to reach the total enteral feeding in neonates[MD=-2.49,95%CI(-3.33,-1.64),P<0.00001],significantly shorten the time to birth weight recovery[MD=-2.11,95%CI(-2.57,-1.66),P<0.00001],and significantly shorten the length of hospital stay[MD=-4.62,95%CI(-5.69,-3.54),P<0.00001],but there was no significant difference in the incidence of necrotizing colitis between the two groups[OR=0.23,95%CI(0.05,1.10),P=0.07].The therapeutic use of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules/Powder could significantly improve the treatment effective rate[OR=5.15,95%CI(2.74,9.68),P<0.00001],significantly shorten the time to reach the total enteral feeding in neonates[MD=-5.18,95%CI(-7.20,-3.16),P<0.00001],significantly shorten the time to birth weight recovery[MD=-3.99,95%CI(-4.41,-3.57),P<0.00001],and significantly shorten the length of hospital stay[MD=-4.01,95%CI(-6.09,-1.92),P=0.0002].Conclusion Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules/Powder can effectively prevent or treat neonatal FI,shorten the time to reach the total enteral feeding in neonates and the length of hospital stay,and promote the growth and development of neonates.