Aims-To evaluate the eVectiveness 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 eVective 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. (Arch Dis Child Fetal Neonatal Ed 1998;79:F105-F109) Keywords: necrotising enterocolitis; oral vancomycin; prophylaxis Necrotising enterocolitis (NEC) is predominantly a disease of premature neonates. It has become the most serious and common gastrointestinal emergency in very low birthweight (VLBW) infants. [1][2][3] Although its exact pathophysiology is not fully understood, three essential elements have been implicated in pathogenesis: (1) immature and/or hypoxicischaemic bowel injury, resulting in the loss of the intestinal mucosal barrier integrity; (2) enteral feeds providing food substrates for intraluminal bacterial growth; and (3) translocation of bacteria or their toxic products across the intestinal mucosal barrier. [4][5][6] As bacterial translocation is considered to be a graded phenomenon 4 and only likely to occur if enteric bacteria exceed a critical population level (>10 9-10 /g of stool in an animal model), 7 therapeutic approaches to lower the intraluminal bacteria density should theoretically decrease the incidence of NEC. [8][9][10][11] Oral vancomycin has been tried 10 11 because of its activity against coagulase negative staphylococci, Clostridium spp, and Gram positive anaerobes, and also because it does not completely sterilise the bowel which could promote colonisation by unwanted pathogens.Vancomyc...

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