Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial

Rougé, Carole; Piloquet, Hugues; Butel, Marie‐José; Berger, Bernard; Rochat, Florence; Ferraris, Laurent; Robert, C.; Legrand, Arnaud; Cochetière, Marie-France de la; Nguyen, Jean–Michel; Vodovar, M; Voyer, M; Darmaun, Dominique; Rozé, Jean‐Christophe

doi:10.3945/ajcn.2008.26919

Cited by 191 publications

(147 citation statements)

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“…Kitajima et al (34) found less gastric aspirates (Bifidobacterium breve), while Rougé et al (35) (mixture of Lactobacillus rhamnosus GG and Bifidobacterium longum) and Oncel et al (31) (L. reuteri) demonstrated reductions in time to full enteral feeds. We did not find any improvements in this regard.…”

Section: Discussionmentioning

confidence: 99%

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

et al. 2014

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Background: Specific probiotics prevent necrotizing enterocolitis (NEC). A mixture of lactobacilli and bifidobacteria (Infloran) was highly effective in Asian very-low-birth-weight (VLBW) infants. We analyzed the effect of Infloran on NEC, NEC severity, and the influence of enteral feedings (breast milk vs. formula) on NEC prevention in a cohort of European VLBW infants. Methods: Infloran was implemented for routine use at our department. VLBW infants receiving probiotics were prospectively followed (2010)(2011)(2012) and compared with historic controls (2008)(2009). Data on NEC, neonatal morbidity, feeding tolerance, and descriptive parameters on NEC cases were analyzed. results: Infloran had no statistically significant impact on NEC (controls: 24/233 (10.3%); probiotics: 16/230 (7%); P = 0.2). However, NEC was significantly reduced in infants of the probiotics group who were fed any breast milk (20/179 (11.2%) vs. 10/183 (5.5%); P = 0.027), whereas it was ineffective in infants exclusively fed formula (4/54 (7.4%) vs. 6/44 (13.6%); P = 0.345). Occurrence of severe NEC (IIIb), time until full feeds, and gastric residuals were similar. conclusion: Infloran was of lower efficacy in a European VLBW cohort and showed a reduction of NEC only in infants fed breast milk. Future studies should investigate the influence of feeding formula or breast milk on the effect of probiotics.n ecrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in premature infants (1). Although its pathogenesis is incompletely understood, a relation to an immature intestinal barrier, aberrant bacterial colonization, and enteral feedings is well established (2). Due to the seriousness of the disease, preventive strategies like the use of human milk and standardized feeding protocols (3-5) are of highest interest.Probiotics are microorganisms that confer a health benefit after ingestion (6). They are generally regarded as safe, and only single cases of sepsis were described in patients with major comorbidities (7). In preterm infants, probiotics may act beneficially by improving the intestinal barrier (8) and promoting a healthy gut microflora (9). Furthermore, they exert antiinflammatory effects on the gut epithelium (10) and improve local and systemic immune responses (11) that may strengthen a preterm infant's still immature immune defense. In the recent past, a preventive effect against NEC was assumed (12), and a variety of probiotic preparations were studied in randomized trials. Meta-analyses of these trials reported on a reduction of NEC in very-low-birth-weight (VLBW) infants by 65% (13,14), and the use of probiotics in clinical routine was recommended. Based on these suggestions, we decided to introduce probiotics for NEC prophylaxis as standard of care at our department. The probiotic preparation Infloran (Laboratorio Farmaceutico, Mede, Italia) consists of a mixture of Lactobacillus acidophilus and Bifidobacterium infantis and was chosen as its use was suggested by European experts (14) and it was available ...

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Section: Discussionmentioning

confidence: 99%

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

et al. 2014

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“…The first studies on the gut bacterial colonization in preterm infants, based on culture methods and performed in the 80s, described a delayed colonization by many of the bacteria found in healthy fullterm infants [121][122][123]. However, more recent studies reported a greater delay either by culture [124][125][126] or cultureindependent methods [50,124,[126][127][128][129][130]. Recently, the use of a pyrosequencing-based method confirmed this aberrant pattern in low and very low birth weight infants [52].…”

Section: Gut Bacterial Establishment In Preterm Neonatesmentioning

confidence: 89%

Usefulness of Probiotics for Neonates?

Butel¹,

Waligora‐Dupriet²,

Aires³

2012

Probiotics

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“…On the other hand, other randomized trials have shown no difference in the time to attain full feeds between study and control infants 7,15 or of the volume of enteral feeds tolerated at 28 days after enrolment in the study 16 . Another randomized placebo-controlled trial has shown a decrease in "time to reach full feeds" in only infants with birth weight >1000 grams but not <1000 grams 17 .…”

Section: Discussionmentioning

confidence: 99%

The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants

Rajput¹,

Filipovska²,

Hewson³

2017

Turk J Pediatr

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Probiotics in preterm infants -research evidence and safetyResults of a recent meta-analysis of 20 randomized controlled trials confirm that probiotic supplementation significantly reduces the risk of definite (i.e., Bell Stage 2 or higher 1 ) necrotizing enterocolitis (NEC) [Relative risk = R 0.33; 95% Confidence Intervals (CI) = 0.24-0.46; p < 0.0001] and all-cause mortality (Relative risk = 0.56; 95% CI = 0.43-0.73; p < 0.0001) without any significant adverse effects in preterm very low birth weight infants 2 . The effect of probiotics on preterm gut is mediated through multiple mechanisms including decrease in intestinal bacterial colonization 3 , increase in intestinal blood flow 4 , improved balance of gut microbial ecology, strengthening of mucosal barrier function 5 , modification of host response to microbial products, augmentation of immunoglobulin A mucosal responses, enhancement of enteral nutrition to inhibit the growth of pathogens, production of antimicrobial proteins, and competitive exclusion of potential pathogens 6 .Another large randomized trial (n = 999) has shown a reduction in late-onset sepsis in babies born ≥28 weeks gestation (p = 0.01) but not <28 weeks 7 as a result of probiotic administration. This trial showed a significant difference in weight at 28 days of life (p=0.04)

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Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial

Abstract: Supplementation with BB536-LGG may not improve the gastrointestinal tolerance to enteral feeding in very-low-birth-weight infants but may improve gastrointestinal tolerance in infants weighing >1000 g. This trial was registered at clinicaltrials.gov as NCT 00290576.

Cited by 191 publications

References 32 publications

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

Usefulness of Probiotics for Neonates?

The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants

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