To Prevent Premature Infant Necrotizing Enterocolitis Born Bacteria Screening Strategy Research

Objective Since previous studies had overlooked the specific effects of different probiotics on premature infants,this study compared the efficacy of probiotics and placebo in the treatment of necrotizing enterocolitis(NEC)in premature infants,we use Meta analysis evaluate the safety and effect and strict effect of specific probiotic genera,and then use the network meta-analysis(Network Meta-analysis,NMA),to determine the best prevention strategy of necrotizing enterocolitis in preterm neonates.Methods Two independent researchers searched through CNKI,the Wan Fang database,Pub Med,MEDLINE,EMBASE,and the Cochrane Central Register of Controlled Trials and selected relevant academic articles until December 2019.Two independent researchers screened the studies to include only randomized controlled trials(RCTs)and extracted data from the included studies to assess the risk of bias and quality of evidence,perform meta-analysis using Review Manager 5.3,and perform NMA using Win BUGS 1.4.3 and Stata13.1.Results A total of 34 studies including 9171 premature infants were included in this study,including 4648 children treated with probiotics.Meta-analysis showed that the risk of NEC in the probiotics group was significantly lower than that in the placebo group [OR=0.56,95% CI(0.46,0.68),P < 0.00001],the risk of sepsis in the probiotics group was significantly lower than that in the placebo group [OR=0.84,95%CI,(0.74,0.95),P=0.004],and the mortality in the probiotics group was significantly lower than that in the placebo group [OR=0.70,95%CI,(0.58,0.83),P<0.0001].Probiotics had an advantage in the prevention of necrotizing enterocolitis(3.54%),sepsis(15.59%),and the reduction of premature mortality(5.23%),all have statistical significance.According to the subgroup analysis based on the type of probiotics,the mixture of probiotics showed great advantages and vitality in the prevention of necrotizing enterocolitis(2.48%),sepsis(18.39%)and the reduction of premature mortality(5.57%).Meta-analysis results showed that the risk of NEC in the probiotics mixture group was significantly lower than that in the placebo group[OR=0.38,95%CI,(0.27,0.54),P<0.00001].Compared with the placebo group,the incidence of sepsis in the probiotics mixture group was significantly lower [OR= 0.82,95%CI,(0.69,0.98),P =0.03].The mortality in the probiotics mixture group was significantly lower [OR=0.58,95%CI,(0.42,0.71),P<0.00001],all have statistical significance.There were no significant differences in the incidence of NEC,sepsis,or mortality among preterm infants treated with a single probiotic intervention compared to the placebo group.Five types of probiotics were used in the included studies:Lactobacillus in 6 studies;Bifidobacterium in 8 studies;Bacillus in 1 study;Saccharomyces in 4 studies and probiotic mixture in 15 studies.This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants.A probiotic mixture showed effectiveness in reducing mortality in preterm infants.Conclusion This study compared the preventive effect of probiotics and placebo on NEC in premature infants by using meta-analysis and meta-analysis on the Internet.The conclusions are as follows: This study mainly elaborated five probiotic strategies,and the results showed that probiotics had an overall advantage in reducing the incidence of NEC,sepsis and premature infant mortality.Probiotic mixture and Bifidobacterium showed advantages in the prevention of NEC,while the probiotic mixture had a lower incidence of NEC than Bifidobacterium.Probiotic compounds showed great advantages in the prevention of sepsis and mortality in premature infants,while single probiotics did not have a good effect.Probiotic intervention has a significant effect on the prevention of premature infant related complications,among which the best probiotic prevention strategy is the combined application of probiotics containing Bifidobacteria;Further research will explore more reasonable biological flora regulation modes based on the interaction between probiotics and the intestinal tract of premature infants,so as to provide better probiotic strategies for prevention of NEC.