REVIEW ER 'S CONCLUSIONS Evidence suggests that oral antibiotics reduce the incidence of NEC in low birth weight infants .
BACKGROUND Necrotizing enterocolitis continues to be a problem , particularly in preterm neonates .
There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis .
This systematic review was undertaken to clarify the issue .
OBJECTIVES To evaluate the benefits and harms of enteral antibiotic prophylaxis for  necrotizing enterocolitis in low birth weight and preterm infants .
Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants
AIMS To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis  in preterm , very low birthweight infants . METHODS A prospect i ve , double blind , r and omised , 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 r and omly 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
REVIEW ER 'S CONCLUSIONS Evidence suggests that oral antibiotics reduce the incidence of NEC in low birth weight infants .
BACKGROUND Necrotizing enterocolitis continues to be a problem , particularly in preterm neonates .
There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis .
This systematic review was undertaken to clarify the issue .
OBJECTIVES To evaluate the benefits and harms of enteral antibiotic prophylaxis for  necrotizing enterocolitis in low birth weight and preterm infants .