Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis
- 作者列表："Ma, Aijia","Yang, Jing","Li, Yang","Zhang, Xuepeng","Kang, Yan
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.
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。
METHODS:INTRODUCTION:Continuous albuterol is a mainstay in management of pediatric status asthmaticus. While the National Heart Lung and Blood Institute Asthma Guidelines suggest 0.5 mg/kg/hr as the recommended dosage, there is a paucity of evidence comparing different weight based rates on hospital outcomes. METHODS:Patients requiring continuous albuterol for asthma exacerbation from January 2015 to December 2016 were identified using ICD codes. The concentration of albuterol (5 mg/h - 20 mg/h) and the duration of treatment were used to determine total albuterol administration. After dividing by patient weight, average weight based doses were divided into equal quintiles. Unadjusted and length of stay adjusted for age, initial asthma severity score, and administration of magnesium were compared among the quintiles. The same multivariate analysis was used for duration of continuous albuterol. RESULTS:533 hospitalizations for asthma were identified of which 289 received continuous albuterol. Weight based dosage quintiles ranged from lowest (0.07 - 0.29 mg/kg/hr) to the highest (>0.76 - 3.2 mg/kg/hr). Baseline characteristics were similar aside from age, race, and magnesium administration. There was no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles. CONCLUSION:No optimal weight based dose of continuous albuterol was found. Further investigation is needed to see if lower amounts of continuous albuterol may be as efficacious as higher doses. This could improve cost of status asthmaticus management and limit the number of adverse events associated with high exposure to continuous albuterol.
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.
METHODS:Background. Extensive studies have focused on the diagnosis and treatment of Mycoplasma pneumoniae infection; however, rare studies investigated the posttreatment conditions. We analyzed the carrying status of M. pneumoniae in the respiratory tract of children before and after treatment. Methods. Ninety-two children with M. pneumoniae pneumonia were included in this study. Clinical data were obtained from each patient, and pharyngeal swab sampling was performed at preliminary diagnosis and discharge. Real-time PCR and dilution quantitative culture were utilized to determine the DNA quantification and number of viable M. pneumoniae from samples collected upon preliminary diagnosis and discharge. Results. All the 92 cases showed DNA positivity upon preliminary diagnosis, serum IgM antibody was detected in 80 patients, and positivity of M. pneumoniae culture was observed in 82 cases. Upon discharge, the M. pneumoniae nucleotide and culture positivity were detected in 87 and 49 cases, respectively. The content of viable M. pneumoniae was 10–104 CCU/mL and 10–102 CCU/mL in the preliminary diagnosis samples and discharge samples, respectively. Conclusions. Real-time PCR was rapid and effective for the qualitative diagnosis of M. pneumoniae at the early stage, but it cannot be used to evaluate the prognosis of patients with M. pneumoniae infection. Quantitative analysis for M. pneumoniae DNA could not directly reflex the viable strain content.