Abstract：
Various studies have shown that oropharyngeal colostrum application (OPCA) is beneficial to preterm neonates. We performed a systematic review and meta-analysis to assess whether OPCA reduces the incidence of culture-proven neonatal sepsis in preterm neonates. Randomized controlled trials comparing OPCA with placebo or standard care in preterm neonates were included. Medline, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature, Scopus, and CENTRAL were searched for studies published up to June 15, 2023. We used the Cochrane Risk of Bias tool, version 2, for risk of bias assessment, the random-effects model (RevMan 5.4) for meta-analysis, and Gradepro software for assessing the certainty of evidence. Twenty-one studies involving 2393 participants were included in this meta-analysis. Four studies had a low risk of bias, whereas seven had a high risk. Oropharyngeal colostrum significantly reduced the incidence of culture-proven sepsis (18 studies, 1990 neonates, risk ratio [RR]: 0.78, 95% confidence interval [95% CI]: 0.65, 0.94), mortality (18 studies, 2117 neonates, RR: 0.73, 95% CI: 0.59, 0.90), necrotizing enterocolitis (NEC) (17 studies, 1692 neonates, RR: 0.59, 95% CI: 0.43, 0.82), feeding intolerance episodes (four studies, 445 neonates, RR: 0.59, 95% CI: 0.38, 0.92), and the time to full enteral feeding (19 studies, 2142 neonates, mean difference: -2 to 21 days, 95% CI: -3.44, -0.99 days). There was no reduction in intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, ventilator-associated pneumonia, neurodevelopmental abnormalities, hospital stay duration, time to full oral feeding, weight at discharge, pneumonia, and duration of antibiotic therapy. The certainty of the evidence was high for the outcomes of culture-positive sepsis and mortality, moderate for NEC, low for time to full enteral feeding, and very low for feeding intolerance. OPCA reduces culture-positive sepsis and mortality (high certainty), NEC (moderate certainty), and time to full enteral feeding (low certainty) in preterm neonates. However, scarcity of data from extremely premature infants limits the generalizability of these results to this population.
摘要：
各种研究表明，口咽初乳应用（OPCA）对早产新生儿有益。我们进行了系统评价和荟萃分析，以评估OPCA是否降低了早产儿经培养证实的新生儿败血症的发生率。包括比较OPCA与安慰剂或标准护理在早产新生儿中的随机对照试验。Medline,Embase,WebofScience,护理和相关健康文献的累积指数，Scopus,搜索了CENTRAL截至2023年6月15日发表的研究。我们使用了Cochrane偏差风险工具，版本2，用于偏差风险评估，用于荟萃分析的随机效应模型(RevMan5.4)，以及用于评估证据确定性的Gradepro软件。这项荟萃分析包括21项研究，涉及2393名参与者。四项研究的偏倚风险很低，而七个风险很高。口咽初乳可显着降低培养证实的败血症的发生率（18项研究，1990年新生儿，风险比[RR]：0.78，95%置信区间[95%CI]：0.65，0.94)，死亡率(18项研究，2117名新生儿,RR：0.73，95%CI：0.59，0.90），坏死性小肠结肠炎（NEC）（17项研究，1692名新生儿，RR：0.59，95%CI：0.43，0.82），喂养不耐受发作(四项研究，445名新生儿,RR：0.59，95%CI：0.38，0.92），以及完全肠内喂养的时间(19项研究，2142名新生儿，平均差异：-2到21天，95%CI：-3.44，-0.99天）。脑室内出血没有减少，早产儿视网膜病变,支气管肺发育不良,呼吸机相关性肺炎,神经发育异常,住院时间,完全口服喂养的时间，出院时的体重，肺炎,和抗生素治疗的持续时间。对于培养阳性脓毒症和死亡率的结果，证据的确定性很高，对于NEC来说是适度的，完全肠内喂养的时间低，和非常低的喂养不耐受。OPCA降低了培养阳性败血症和死亡率（高确定性），NEC（中等确定性），早产新生儿完全肠内喂养的时间（低确定性）。然而,来自极早产儿的数据的匮乏限制了这些结果对该人群的普适性.
