Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants
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.
METHODSA 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.
RESULTSNine 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).
CONCLUSIONSProphylactic 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.
© 1998 by Archives of Disease in Childhood
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