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益生菌混合喂养，能降低40％的新生儿脓毒症风险
原创 2017-09-15 翻译：陈志锦 SIFIC感染官微
检索：陈志锦
翻译：陈志锦
审稿：周超群
印度乡村的一项大型研究发现，给新生儿喂养益生菌和益生元碳水化合物的混合物能促进健康细菌生长，从而显著降低脓毒症风险。
来自奥马哈内布拉斯加大学医学中心大学公共卫生学院全球卫生和发展中心流行病学系的Pinaki Panigrahi博士及其同事在《自然》杂志上发表了他们的研究结果。
从出生后第2至第4天开始，新生儿每天接受口服治疗，治疗期为7天，每个婴儿的费用约为1美元，对婴儿进行60天的监测。
与安慰剂组5.4％的死亡率和9％的脓毒症感染率结果相比，接受共生组合治疗组脓毒血症风险减少了40％（风险比为0.60； 95％置信区间，0.48-0.74）。
这是预期的20％风险降低的两倍，并使得数据安全和监测委员会提前停止试验。
作者写道，制剂耐受性良好，胃肠道事件“出奇地低”。仅发生6例腹胀，安慰剂组5例，治疗组1例。
死亡病例很少：安慰剂组为四人，治疗组为六人。作者写道：“这些研究结果表明，发展中国家新生儿脓毒症的比例很大一部分可以通过使用合生素有效预防。” 目前尚无有效的脓毒症预防措施。
加州大学戴维斯分校圣地亚哥分校儿科系和医学政策与研究中心的Daniel J. Tancredi博士在随后的一篇社论中指出，考虑到置信区间，共生治疗的相对风险降低可以达到约25％至50％。
研究人员解释说，他们在Odisha州的随机选择了149个村庄进行了试验，该州在该国新生儿和婴儿死亡率可能是最高的。
脓毒症每年导致全球约100万新生儿死亡，主要发生在发展中国家。除了早产以外，脓毒症是全球婴儿死亡的主要原因（37％）。
作者指出，因为对抗生素耐药性关注的加深，使用益生菌预防或与其他疗法结合使用是有利的。
研究的局限性包括研究人员没有登记早产（小于35周妊娠期）或低出生体重（少于2000克）的婴儿，这些群体具有较高脓毒症死亡风险。
研究区域有7089名婴幼儿，他们还排除了2506名新生儿早期发病和死亡的婴儿。
这些结果能否扩展到发展中国家的所有高危婴儿，需要进一步的研究来确定。
来源：http://www.medscape.com/viewarticle/884455
原文
Probiotic Mix Fed to Indian Infants Cuts Newborn Sepsis Risk by 40%
Feeding newborns a combination of a probiotic bacterium and a prebiotic carbohydrate that promotes healthy bacteria significantly reduced sepsis risk, a large study in ruralIndiafound.
Pinaki Panigrahi, MD, from the Department of Epidemiology, Center for Global Health and Development, College of Public Health at University of Nebraska Medical Center in Omaha, and colleagues publishedtheir findings online August 16 in Nature.
Newborns received the oral treatment costing about $1 US per baby beginning on days 2 to 4 of life and then each day for a total of 7 days. The babies were monitored for 60 days.
The group that received the symbiotic combination had a 40% reduction (risk ratio, 0.60； 95% confidence interval, 0.48 - 0.74) in the combined outcome of death and sepsis compared with the placebo group (5.4% vs 9%, respectively.)
That was twice the 20% risk reduction expected, which led the data safety and monitoring board to stop the trial early.
The preparation was well tolerated, and gastrointestinal events "were surprisingly low," the authors write. Only six cases of abdominal distention (five in the placebo group； one in the treatment group) occurred.
Deaths were rare: four in the placebo group and six in the symbiotic group.
"These findings suggest that a large proportion of neonatal sepsis in developing countries could be effectively prevented using a synbiotic," the authors write. No effective prevention for sepsis is currently available.
Daniel J. Tancredi, PhD, from the Department of Pediatrics and the Center for Healthcare Policy and Research at University of California, Davis, in Sacramento, points out in an accompanying editorial that taking into account confidence intervals, the relative risk reduction for the symbiotic treatment could be from about 25% to 50%.
They conducted the trial in 149 randomly chosen villages in Odisha state, which has some of the highest neonatal and infant death rates in the country, the researchers explain.
Sepsis results in about 1 million newborn deaths globally every year, mostly in developing countries. In addition to prematurity, sepsis is a major cause of infant deaths globally (37%).
Using a probiotic in prevention or in combination with other therapies is advantageous as concerns deepen about antibiotic resistance, the authors note.
Study limitations include that researchers did not enroll premature (less than 35 weeks of gestation) or low birthweight (less than 2000 g) babies, groups that have a higher risk of dying from sepsis.
They also excluded 2506 infants (of 7089 births in the study region) who had major causes of morbidity and mortality in the early neonatal period.
Further studies would be needed to determine whether these results would extend to all at-risk infants in developing countries.
图文：朱迪
审稿：高晓东 马嘉睿
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