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Archives of Disease in Childhood - Fetal and Neonatal Edition 1998;79:F105-F109; doi:10.1136/fn.79.2.F105
Copyright © 1998 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child Fetal Neonatal Ed 1998;79:F105-F109 ( September )

Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants

Y K Siu,a P C Ng,a S C K Fung,b C H Lee,a M Y Wong,c T F Fok,a K W So,a K L Cheung,a W Wong,a A F B Chengb

a Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, b Department of Microbiology, c Department of Mathematics, The Hong Kong University of Science and Technology

Correspondence to: Professor PC Ng Department of Paediatrics, Level 6, Clinical Science Building, Prince of Wales Hospital, Shatin, New Territories Hong Kong People's Republic of China.


Accepted 15 March 1998

AIMS---To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis in preterm, very low birthweight infants.
METHODS---A prospective, double blind, randomised, placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 140 very low birthweight infants consecutively admitted to the neonatal unit. The babies were randomly allocated to receive oral vancomycin (15 mg/kg every 8 hours for 7 days) or an equivalent volume of placebo solution. Prophylaxis was started 24 hours before the start of oral feeds. All suspected cases of necrotising enterocolitis were investigated with a full sepsis screen and serial abdominal radiographs. Necrotising enterocolitis was diagnosed and staged according to modified Bell's criteria.
RESULTS---Nine of 71 infants receiving oral vancomycin and 19 of 69 infants receiving the placebo solution developed necrotising enterocolitis (p=0.035). Infants with necrotising enterocolitis were associated with a significant increase in mortality (p=0.026) and longer duration of hospital stay (p = 0.002).
CONCLUSIONS---Prophylactic oral vancomycin conferred protection against necrotising enterocolitis in preterm, very low birthweight infants and was associated with a 50% reduction in the incidence. However, widespread implementation of this preventive measure is not recommended, as it would only be effective in necrotising enterocolitis caused by Gram positive organisms and could increase the danger of the emergence of vancomycin resistant or dependent organisms. Its use should be restricted to a high prevalence nursery for a short and well defined period in a selected group of high risk patients.

Keywords: necrotising enterocolitis; oral vancomycin; prophylaxis


© 1998 by Archives of Disease in Childhood

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