RESUMO
INTRODUCCIÓN: Los recién nacidos pretérminos y de muy bajo peso presentan mayor riesgo de enterocolitis necrosante (NEC) dado que su colonización a nivel intestinal se produce más tardíamente y es diferente respecto a los recién nacidos a término, además de presentar con mayor frecuencia otros factores favorecedores como isquemia intestinal. Se cree que los probióticos pueden modificar la microbiota y la respuesta immune de los recién nacidos, disminuyendo la incidencia de NEC. OBJETIVO: Revisar los estudios realizados con diferentes probióticos y comparar diferentes combinaciones de éstos para ver si es beneficiosa su administración de forma rutinaria en recién nacidos pretérmino de menos de 1500g para evitar la enterocolitis necrosante, reducir la sepsis tardía y la mortalidad. Material y MÉTODOS: Se llevó a cabo una revisión sistemática entre enero 1980 y marzo 2014, en MEDLINE, EMBASE y Cochrane Central Register of Controlled Trials. Se seleccionaron los estudios clínicos con recién nacidos prematuros de <1500g y/o <34 semanas descartando aquellos con puntuaciones de Jadad menores de 4. RESULTADOS: Se seleccionaron 9 estudios, de 24 pre-seleccionados, con un total de 3521 recién nacidos. Se observó que los probióticos reducen la incidencia de NEC (RR 0,39; 95% CI: 0,26-0,57) y la mortalidad (RR 0,70; 95% CI: 0,52-0,93). No se detectaron diferencias significativas con el placebo en la disminución de sepsis tardía (RR 0,91; 95% CI: 0,78-1,96). Finalmente, cuando se analizan las distintas cepas, la combinación de 2 probióticos (Lactobacillus acidophiluscon Bifidobacterium bifidum) demostró reducir la mortalidad de forma significativa comparada con otras combinaciones de probióticos (RR 0,32; 95% CI: 0,15-0,66, NNT 20; 95% CI: 12-50). CONCLUSIONES: Los probióticos son beneficiosos en cuanto a la prevención de NEC y reducen la mortalidad en pretérminos de menos de 1.500g. Además, la combinación de dos probióticos (Lactobacillus acidophilus con Bifidobacterium bifidum) presenta mayor beneficio. Dada la diferencia de composición de probióticos son necesarios estudios aleatorizados comparando diferentes combinaciones de probióticos
INTRODUCTION: Necrotising enterocolitis (NEC) is one of the most common and serious acquired bowel diseases a premature newborn can face. This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500g. METHODS: A systematic review of randomised controlled trials, between January 1980 and March 2014, on MEDLINE, the Cochrane Central Register of Controlled Trials, together with EMBASE, was carried out. Studies with infants <1500g or <34 weeks were selected, discarding those with Jadad scores lower than 4. RESULTS: 9 studies were selected for further investigation, pooling a total of 3521 newborns. Probiotics were found to reduce the NEC incidence (RR 0.39; 95% CI: 0.26-0.57) and mortality (RR 0.70; 95% CI: 0.52-0.93), with no difference to placebo regarding late-onset sepsis (RR 0.91; 95% CI: 0.78-1.06). Finally, when analysing the different strands, the use of a 2-probiotic combination (Lactobacillus acidophilus with Bifidobacterium bifidum) proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations (RR 0.32; 95% CI: 0.15-0.66, NNT 20; 95% CI: 12-50). CONCLUSIONS: Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates. Moreover, the combination of 2 probiotics (L. acidophilus with B. bifidum) seems to produce the greatest benefits. However, due to the differences in probiotic components and administration, it would be wise to perform a randomised controlled trial comparing different probiotic mixtures
Assuntos
Humanos , Recém-Nascido , Probióticos/uso terapêutico , Enterocolite Necrosante/dietoterapia , Sepse/prevenção & controle , Recém-Nascido de muito Baixo Peso , Mortalidade Infantil , Doenças do Prematuro/prevenção & controle , Padrões de Prática MédicaRESUMO
INTRODUCTION AND OBJECTIVE: Necrotising enterocolitis (NEC) is one of the most common and serious acquired bowel diseases a premature newborn can face. This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500g. MATERIAL AND METHODS: A systematic review of randomised controlled trials, between January 1980 and March 2014, on MEDLINE, the Cochrane Central Register of Controlled Trials, together with EMBASE, was carried out. Studies with infants <1500g or <34 weeks were selected, discarding those with Jadad scores lower than 4. RESULTS: 9 studies were selected for further investigation, pooling a total of 3521 newborns. Probiotics were found to reduce the NEC incidence (RR 0.39; 95%CI: 0.26-0.57) and mortality (RR 0.70; 95%CI: 0.52-0.93), with no difference to placebo regarding late-onset sepsis (RR 0.91; 95%CI: 0.78-1.06). Finally, when analysing the different strands, the use of a 2-probiotic combination (Lactobacillus acidophilus with Bifidobacterium bifidum) proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations (RR 0.32; 95%CI: 0.15-0.66, NNT 20; 95%CI: 12-50). CONCLUSIONS: Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates. Moreover, the combination of 2 probiotics (Lactobacillus acidophilus with Bifidobacterium bifidum) seems to produce the greatest benefits. However, due to the differences in probiotic components and administration, it would be wise to perform a randomised controlled trial comparing different probiotic mixtures.
