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    13 views7 pages

    Sepsis Neontal 3

    Uploaded by

    anamaria castellano

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    © All Rights Reserved
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    Reviews Prebiotics and sepsis in infants: An updated systematic review and meta-analysis Yuaja Gin", Linhui Pan Anstey Department Tarr spl ila to Ganga Mel Vest, Nang, Che * env Care Unt Liou Pope’ Hosp Alatedo Guang Medial Urversty,China » aang Cl Reserch enter for nestesioy( ADS, Nang hia «xanga et Commision fy Labraary of fs Scece an Preven of eraperave Organ Diu, ating, he A-researdhaneptand design 8~caecon nr asenbhy of dats; C— dat analysis and ntereaton (wing the ariel revs fhe ate Final appovaet eile eres ad eer etn, 159 199-76 iN T-240f) Aine 208 Adres coespndene Abstract mala ze. Background, Sepia cia statin, an is teatment and reduction ae portant nal sues, van Aoi 2 routne tetment option, but the ackerse effets ae a cancer in pediatric pate, funding sources ily infnts Preis igh be an aerate option ceed pmecioetnnetsr especal fs, Prebs moh an eae ot YejaiiPencangaeh cents updated steric review an ofr ‘eine to angi (Objectives. The ar ofthis study wast provide an updated systemic review and mea ata ora erie oe iia (RT) onthe use feb sepsis in inva, which cou ast lias Conti of nterest in deca wheter ous ths eaten Nene Methods. Testu nuded RCTs reed prebiotics and sessin ifn Atandom eects modeland theo rato OR were api estimate the ete of reiticuse andthe indecent ecden nah 00 Theanine 6 stucies wth atta of 438i. The par outcome was the OR f sepsis Revewedan fot). 209 infants wha received eis, feeder e125 Results, Theresa efthemets-aalsderenstate thatthe pled OR ops assent loner Pence, 04 fairs who ses pret, Homes the ress inated a medium et heengenety. Conclusions. Iheresuts sowed that he use of rebits might be associated ith ection of sepsis in ifn. The standardized aplication of his tetment gt be an intrguing opi fx ute cnc researc ey words: spss, metres, esate, pbc Giteas {in Po. ria ein Andee stemacreven nde Iblstedonses abet anu 208. Aarne 1 dons ot Copyright Capriptoy aoe svar tdedndertbe este (eat Commes bitin Opa) baleen 3.8) in. Pa. Preis an sept Introduction Infants are prone to sepsis, especially those with lower birth weight, lower gestational age, asphyxia, and those administered antibiotics." In addition, infants can ea: ily contract infections, such as necrotizing enterocolitis, which can lead to sepsis and alterations in laboratory parameters.* Changes in non-cytotoxic T lymphocytes could also occur after the onset of sepsis due to the sup- pression of immune function in infants.* Furthermore, sepsis in infants may result in warm shock physiology accompanied by vasodilation, which could contribute to seplic shock and increase the mortality rate Theze- fore, understanding the relationship between infants and sepsis is critical ‘The therapeutic options for treating sepsis in infants are limited, Mechanical ventilation and empirical anti- biotics have been reported to be associated with higher sepsis frequency in infants~* Thus, clinicians may need to establish other therapeutic options for such patients, and one possible alternative is prebiotics. The current evi- dence on the mechanisms of prebiotics in immune fanc- tion mostly comes from animal studies, which provide clues about how to relieve sepsis in infants through im- munomodulatory actions. Prebiotics could promote the growth of beneficial bacte- ria, enhance immune-stimulatory processes, and increase the expression of immunomodulatory functions with anti- oxidant characteristics” * Furthermore, they may enhance intestinal trophic effects and immune system maturation," Oligosaccharides from human breast milk are prebiotics that have been shown to modulate immune responses," which is consistent with the latest studies on the mecha- nisms of prebiotc effects on immunomodulatory function, Inaddition, prebiotics seem to have no significant side ef- fects and may help to avoid mechanical ventilation use in infants. Therefore, they have the potential to decrease sepsis risk in such patients > Objectives Sepsisis critical situation in clinical practice for which antibiotic therapy is a routine option. However, adverse effects of antibiotics have to be considered in pediatric patients, This meta-analysis aimed to provide an update fon the effects of prebiotic use in sepsis events in infants. Based on the literature, we hypothesized that prebiotics would decrease the risk of sepsis. We included randomized controlled trials (RCTS) with placebo controls (no admin- istration of prebiotics) due to the lower risk of bias in such studies, The results could provide valuable information fon how to manage infants. Methods Literature database and enrollment criteria ‘Wesearched the literature using the following keywords: “prebiatic," “versus,” “placebo,” “compatison, “short-chain salacto-oligosaccharides,” “long-chain fructo-oligosac- charides,"“pectin-derived acidic oligosaccharides," “acidic oligosaccharides,” “sepsis” “neonate,” "infant," “septic,” “oligosaccharides,” “fructans,” “oligofructose,” “inulin, “randomized,” “clinical,” “controlled,” “trials “treatment,” “therapy,” “efficacy,” and “outcome” We searched the Sci- enceDirect, PubMed, Web of Science, Embase, and the Co- crane Central Register of Controlled Trials databases for relevant prospective RCT studies published before October 2022, The inclusion criteria were: 1. Studies comparing prebiotics with placebo in infants; 2, Those with informa tion on the sepsis characteristics, including the occurrence and rales; 3. Reports published in journals in the Science Citation Index Database written in English; and 4, RCTs with a placebo-controlled design. Assessment of study quality and data collection ‘We conducted the meta-analysis in accordance with, the Cochrane Handbook for Systematic Reviews and Inter- ventions! and the Preferred Reporting Items for System- atic Reviews and Meta-Analyses (PRISMA) guidelines.'* Data collected from the studies included sepsis events, the number of infants who experienced such events after receiving prebiotics or a placebo, the odds ratio (OR), and the standard error (SE). Data collection and assessment ‘Two reviewers screened abstracts and collections of ar ticles and extracted data on sepsis outcomes from the texts, tables and figures. The risk of bias was then assessed ac- cording to the following criteria: 1. Bias arising from the randomization process; 2, Bias due to deviations from intended interventions; 3. Bias due to missing outcome data; 4. Bias in the measurement of the outcomes, and 5, Bias in the selection of the reported results. The re viewers showed strong agreement in their assessments (kappa = 0.9), Ultimately, the final results were reviewed by all authors Meta-analysis and statistical analysis ‘Wegenerated pooled estimates of the relative risks (RRs) and ORs for sepsis events and prebiotic treatments and used the Cochrane Collaboration Review Manager Soft- ware Packsge RevMan v, 54 (Cochrane Collaboration, Copenhagen, Denmark) to perform the meta-analyses. vin es. 208 "The Mantel-Haenszel method was used to calculate RR, with DerSimonian and Laird’s random effects models and summary statisties also produced. The risk estimates of individual studies were combined using the variance- ‘weighted averages in the random effects model ‘The group that received prebiotic treatments and the con: ‘trol group were compared to determine whether prebiotics decreased the rate of sepsis events. The x? tests were per- formed, and the statistic was used to examine the hetero- geneity between studies. According o the Cochrane Hand book for Systematic Reviews and Interventions the choice betweena fixed-effect and a random-effects meta-analysis should not solely be made according o the statistical test for heterogeneity. Methodological or conceptual heterogene ity is unavoidable in a meta-analysis, so a random effects model may be more reasonable. Therefore, a random effects model was applied in this study. Two-sided p-values were ‘obtained from the statistical analyses, anda funnel plot was used to assess publication bias Results Study screening and enrollment After the inital search, 112articles were selected, with no auditional record fund from other sources, These articles Included 59 duplicates, which were removed. After evaluat ing the relevance ofthe abstracts and titles of the remaining, Sdarticles, 19 were excluded, The all texts ofthe remaining B4articles were screened, and 18 more were discarded. Ultimately, 16 articles were included in the meta-analy. sis."91 The PRISMA flow diagram ofthis study is shown, in Fig. 1. The prebiotics group included 3,211 infants, with 3,227 infants in the control group (the total population size ‘was 6438), Table I summarizes the demographic data and characteristics ofthe 16 studies, Figure 2 shows the assess- ment of risk bias of the included 16 studies. Risk ratio and odds ratio of sepsis events between groups The prebiotics group had a significantly lower RR of sep sis events according to the random effects model Z,= 3:70 and p = 0.001 for overall effect). Low heterogeneity was obtained, with an F value of 32% (Fig. 3). The prebiotics rroup also had a significantly lower OR of sepsis events cording to the model (Z.= 3.31 and p = 0,001 for overall effect), and the heterogeneity was low, wit of 38% (Fig. an P value Discussion The results suggest that prebiotic treatment could be ben- ficial for reducing the rate of sepsis events in this large sample of infants, which was supported by the RR, OR and 95% confidence intervals (95% Cls), One strength of this Records identified tough database searching (=) ‘ ‘Additional records identified ‘through ather sources Fig, 1. Peete Renating ers fr SprematicResens and Wetaraes (Parva owenart The scerifeaton and {elector of potently elvan ere, | | Records after duplicates removed (n=53) though abst: aa ie sceenn, chard tothe PIER guidehnes, Toefl ents of ele tudes were sable articles were sal metanabis | Records screened (m5 acm) (leeaiion Records excluded through tiles and abstract screening ‘due tonon-relevance 19) i Falltextarides assessed fr elgiblty (o=34 | Stusies included Fulton articles excluded with reasons (n= 18) “ino sepsis event data (n=) Snot RIC in= 5) = normal infant study (0 review articles n= 4) 3) in qualitative synthesis * ‘Stusier included in quantitative synthesis n=16) in. an. Preis an epi Table Summary erates susies Ce Cena ‘enanan ea 2oveten* Camgeoto etal porn tracel™ Dasopoulou etal 2018 (Greece) Ge Guneyalet a, ovr trueey™ Lecoufe et at 2014 (eneretanas” uot eral, 2018 (tons? Mosler al 2010 wr Noni eal 2005 (iio teeta. 2015. (ea nets alga etl, 2017 wa kin eta, 2010 rae” Serce eal, 2020 Cure ones ata 2030 fen van den Seng ral, 2013 (re eto Wesabe etal2011 (ie etna" 25 8048 223) weeks ol «compares 180 29802216 "weet le) 24UI5 M95 38541 3 eeks ‘comes 0 34(18 18h S841 4 weet ol) #504072 weeks og) compared 0 82134933 ‘woes ol 100152, 48,2917 vs empire 100, (Sem s2raezar2wece: ol 70097419 .ecks lécomparedio ad boss 1) weeks le e805 M.225 30246 ess al compsresto 45 5K, 195 29520He06 oH) 2B{11M 12A compared ro24(19M FISD BS wees od 73484, 254, 30705 weeks ‘a comoares 41 60M, STRST 205 weeks ol} 108 comsaredto 110 445001 1 Sseke od)

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