Prevention of necrotizing enterocolitis with probiotics: a systematic review and meta-analysis

Abstract

ContextNecrotizing enterocolitis (NEC) is the most frequent gastrointestinal emergency in neonates. The microbiome of the preterm gut may regulate the integrity of the intestinal mucosa. Probiotics may positively contribute to mucosal integrity, potentially reducing the risk of NEC in neonates.ObjectiveTo perform an updated systematic review and meta-analysis on the efficacy and safety of probiotics for the prevention of NEC in premature infants.Data SourcesStructured searches were performed in: Medline, Embase, and the Cochrane Central Register of Controlled Trials (all via Ovid, from 2013 to January 2015). Clinical trial registries and electronically available conference materials were also searched. An updated search was conducted June 3, 2016.Study SelectionRandomized trials including infants less than 37 weeks gestational age or less than 2,500 g on probiotic vs. standard therapy.Data ExtractionData extraction of the newly-identified trials with a double check of the previously-identified trials was performed using a standardized data collection tool.ResultsThirteen additional trials (n = 5,033) were found. The incidence of severe NEC (RR 0.53 95% CI [0.42–0.66]) and all-cause mortality (RR 0.79 95% CI [0.68–0.93]) were reduced. No difference was shown in culture-proven sepsis RR 0.88 95% CI [0.77–1.00].LimitationsHeterogeneity of organisms and dosing regimens studied prevent a species-specific treatment recommendation from being made.ConclusionsPreterm infants benefit from probiotics to prevent severe NEC and death.

The development of probiotics for women’s health

“…In hospital settings, recognition of the value of beneficial microbes is happening, with use of probiotics to reduce mortality and morbidity of low-birth-weight premature babies (Sawh et al 2016) (including in London, Ontario, after 10 years of advocating) and to prevent antibiotic-associated diarrhea including Clostridium difficile infections (Hickson et al 2007;Maziade et al 2015), albeit not all studies have shown efficacy (Allen et al 2013). The success of fecal microbiota transplant in curing C. difficile infections further emphasizes the impact of beneficial microbes (van Nood et al 2013).…”

Safety and risk assessment for the human superorganism

“…Among the microbe-based strategies is the use of probiotics in preterm infants to reduce the risk of necrotizing enterocolitis (Sawh et al 2016). Metabolomics and meta-proteomics are likely to provide useful guidance on microbe-microbe and microbe-host interactions (Mao and Franke 2015;Vernocchi et al 2016).…”

Nutrition for Preterm Infants: 75 Years of History

“…Despite many trials that followed, and an overall clear effect of probiotic supplementation on reducing NEC incidence, probiotics were not used at all units. The heterogeneity of organisms and dosing regimens studied have prevented a species-specific treatment recommendation from being made so far [51][52][53][54]. Furthermore, quality control of the available products remains an issue [55].…”