Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates (Review)

Background: Necrotizing enterocolitis (NEC) is the most common emergency involving the gastrointestinal tract occurring in the neonatal period. There have been published reports that suggest that oral immunoglobulins IgA and IgG produce an immunoprotective effect in the gastrointestinal mucosa. Objectives: To determine the effect of oral immunoglobulin on the incidence of necrotizing enterocolitis and other complications in preterm and/or low birth weight neonates. Search methods: We used the standard search strategy of the Cochrane Neonatal Group.We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2011, Issue 3), MEDLINE (1966 to March 26, 2011), CINAHL (1982 to March 26, 2011) and EMBASE (1980 to March 26, 2011) and conference proceedings. Selection criteria: All randomised or quasi-randomised controlled trials where oral immunoglobulins were used as prophylaxis against necrotizing enterocolitis in preterm (< 37 weeks gestation) and/or low birth weight (< 2500 g) neonates. Data collection and analysis: Data collection and analysis was performed in accordance with the standard methods of the Cochrane Neonatal Review Group. Main results: Five studies on oral immunoglobulin for the prevention of necrotizing enterocolitis were identified of which three met the inclusion criteria. In this review of the three eligible trials (including a total of 2095 neonates), the oral administration of IgG or an IgG/IgA combination did not result in a significant reduction in the incidence of definite NEC [typical RR 0.84 (95% CI 0.57 to 1.25), typical RD -0.01 (95% CI -0.03 to 0.01)], suspected NEC [RR 0.84 (95% CI 0.49 to 1.46), RD -0.01 (95% CI -0.02 to 0.01)], need for surgery [typical RR 0.21 (95% CI 0.02 to 1.75), typical RD -0.03 (95% CI -0.06 to 0.00)] or death from NEC [typical RR 1.10 (95% CI 0.47 to 2.59), typical RD 0.00 (95% CI -0.01 to 0.01)]. REVIEWER'S CONCLUSIONS: Based on the available trials, the evidence does not support the administration of oral immunoglobulin for the prevention of NEC. There are no randomised controlled trials of oral IgA alone for the prevention of NEC.