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Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis

口咽初乳治疗降低极低出生体重儿呼吸机相关性肺炎的发生率: 系统综述和荟萃分析

  • 影响因子:2.86
  • DOI:10.1038/s41390-020-0854-1
  • 作者列表:"Ma, Aijia","Yang, Jing","Li, Yang","Zhang, Xuepeng","Kang, Yan
  • 发表时间:2020-03-30
Abstract

Background Oropharyngeal colostrum (OC) is a novel feeding strategy to prevent complications of prematurity. A meta-analysis was conducted to investigate whether very low birth weight infants (VLBWs) can benefit from OC. Methods Randomized controlled trials (RCTs) were searched from Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials from the date of inception until May 2019. RCTs were eligible if they used OC therapy on VLBW infants. The primary outcomes included ventilator-associated pneumonia (VAP), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), late-onset sepsis, and death. The secondary outcomes included the time of full enteral feeding and the length of stay. Results Eight RCTs involving 682 patients (OC group: 332; non-OC group: 350) were included in the meta-analysis. The results suggested that OC was associated with a significantly reduced incidence of VAP [odds ratio (OR) = 0.39, 95% confidence interval (CI): 0.17–0.88, P  = 0.02] and full enteral feeding days (mean difference = −2.66, 95% CI: −4.51 to −0.80, P  = 0.005), a potential significance of NEC (OR = 0.51, 95% CI: 0.26–0.99, P  = 0.05), a trend toward downregulating mortality (OR = 0.60, 95% CI: 0.34–1.08, P  = 0.09) and proven sepsis (OR = 0.64, 95% CI: 0.40–1.01, P  = 0.06). Conclusions OC could significantly reduce the occurrence of VAP, and consequently, its routine use should be considered for VLBWs to prevent infectious diseases. Impact OC significantly reduces the occurrence of VAP and NEC in VLBW infants. OC may reduce the incidence of VAP and NEC by increasing IgA levels. Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP.

摘要

背景口咽初乳 (OC) 是一种预防早产儿并发症的新型喂养策略。进行荟萃分析,探讨极低出生体重儿 (VLBWs) 能否从 OC 中获益。方法从 Embase 、 PubMed 、 Web of Science 和 Cochrane 中心对照试验登记册检索自开始至 2019年5月的随机对照试验 (RCTs)。如果对 VLBW 婴儿使用 OC 治疗,RCTs 是合格的。主要结局包括呼吸机相关性肺炎 (VAP) 、坏死性小肠结肠炎 (NEC) 、支气管肺发育不良 (BPD) 、晚发性败血症和死亡。次要结局包括全肠内喂养时间和住院时间。结果 8 个 rct,共 682 例患者 (OC 组: 332; 非 OC 组: 350) 纳入 meta 分析。结果提示 OC 与 VAP 发生率显著降低相关 [比值比 (OR) = 0.39,95% 可信区间 (CI): 0.17-0.88, P = 0.02] 和全肠内喂养天数 (平均差异 =-2.66,95% CI:-4.51 至-0.80,P = 0.005),NEC 的潜在意义 (or = 0.51,95% CI: 0.26-0.99,P = 0.05),降低死亡率的趋势 (or = 0.60,95% CI: 0.34-1.08,P = 0.09) 证实为脓毒症 (or = 0.64,95% CI: 0.40-1.01,P = 0.06)。结论 OC 可明显减少 VAP 的发生,应考虑在 VLBWs 中常规使用,以预防感染性疾病。Impact OC 显著降低 VLBW 婴儿 VAP 和 NEC 的发生。OC 可能通过提高 IgA 水平降低 VAP 和 NEC 的发生率。低体重儿机械通气早期 OC 治疗可能预防 VAP 的发生。

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发表时间:2020-01-29
DOI:10.1080/02770903.2020.1723622
作者列表:["Parlar-Chun R","Arnold K"]

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影响因子:2.40
发表时间:2020-02-02
来源期刊:BMC Pulmonary Medicine
DOI:10.1186/s12890-020-1056-7
作者列表:["Joon Young Choi","Jeong Uk Lim","Ho Jung Jeong","Ji Eun Lee","Chin Kook Rhee"]

METHODS:Abstract Background We investigated the association between a combination of two markers, peripheral (PEC) and bronchoalveolar lavage (BAL) eosinophil percentage (BEP), and oxygen requirements in patients with acute eosinophilic pneumonia (AEP). Methods We retrospectively reviewed the medical records of patients with AEP treated at the Armed Forces Capital Hospital between May 2012 and May 2017. We used correlation analyses to assess the association between PEC/BEP and clinical outcomes in AEP patients. Receiver operating characteristic (ROC) curve analyses were used to calculate the cut-off value for BEP that categorised patients requiring a significant oxygen supply. The BAL/blood eosinophil (BBE) score was introduced to stratify patients with peripheral eosinophilia and elevated BEP. Clinical characteristics and outcomes were compared between the different groups. Multiple logistic regression was performed for significant oxygen requirements using two different models using age, C-reactive protein (CRP), smoking duration, and BBE score (model 1) and age, CRP, BEP, and PEC (model 2). Results Among the 338 patients, 99.7% were male, and their mean age was 20.4 ± 1.4 years. Only 0.6% of patients were never smokers and the mean number of smoking days was 26.2 ± 25.4. Correlation analyses revealed that both the PaO2/FiO2 ratio and duration of oxygen supply were associated with BEP. ROC curve analyses indicated a cut-off level of 41.5%. Patients with a high BBE score had favourable outcomes in terms of hypoxemia, hospital days, intensive care unit admission, oxygen supply days, and steroid treatment days. Multiple logistic regression revealed that BEP and BBE score tended to be associated with significant oxygen requirements. Conclusions In this study, we revealed that both peripheral and BAL eosinophilia is associated with favourable outcomes in AEP patients.

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影响因子:2.41
发表时间:2020-01-22
DOI:10.1155/2020/9814916
作者列表:["Fei Zhao","Xuemei Guan","Jing Li","Liyong Liu","Jie Gong","Lihua He","Fanliang Meng","Jianzhong Zhang"]

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