Probiotics Prevent Late-Onset Sepsis in Human Milk-Fed, Very Low Birth Weight Preterm Infants: Systematic Review and Meta-Analysis

Aceti, Arianna; Maggio, Luca; Beghetti, Isadora; Gori, Davide; Barone, Giuseppe; Callegari, Maria Luisa; Fantini, Maria Pia; Indrio, Flavia; Meneghin, Fabio; Morelli, L.; Zuccotti, Gian Vincenzo; Corvaglia, Luigi

doi:10.3390/nu9080904

Cited by 93 publications

(75 citation statements)

References 77 publications

(215 reference statements)

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“…Well-established strategies for NEC prevention should continue to be reinforced, such as giving human breast milk rather than formula, and use of standardised feeding regimens 20 26. Furthermore, there is evidence that use of probiotics can prevent LOS in high-risk preterm infants 24 27 28…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and healthcare factors associated with neonatal enterococcal infections

Wang

Kortsalioudaki

Heath

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo investigate the epidemiology and healthcare factors associated with late-onset neonatal enterococcal infections.DesignMulticentre, multinational retrospective cohort study using prospectively collected infection data from a neonatal infection surveillance network between 2004 and 2016; this was supplemented with healthcare data from a questionnaire distributed to participating neonatal units.SettingSixty neonatal units across Europe (UK, Greece, Estonia) and Australia.PatientsInfants admitted to participating neonatal units who had a positive culture of blood, cerebrospinal fluid or urine after 48 hours of life.ResultsIn total, 414 episodes of invasive Enterococcus spp infection were reported in 388 infants (10.1% of a total 4083 episodes in 3602 infants). Enterococcus spp were the second most common cause of late-onset infection after coagulase-negative Staphylococcus spp and were strongly associated with necrotising enterocolitis (NEC) (adjusted OR 1.44, 95% CI 1.02 to 2.03, p=0.038), total parenteral nutrition (TPN) (adjusted OR 1.34, 95% CI 1.06 to 1.70, p=0.016), increasing postnatal age (per 1-week increase: adjusted OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and decreasing birth weight (per 1 kg increase: adjusted OR 0.85, 95% CI 0.74 to 0.97, p=0.017). There was no evidence that inadequate nurse to patient staffing ratios in high-dependency units were associated with a higher risk of enterococcal infections.ConclusionsEnterococcus spp were the second most frequent cause of late-onset infections. The association between enterococcal infections, NEC and TPN may inform empiric antimicrobial regimens in these contexts and provide insights into reducing these infections.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and healthcare factors associated with neonatal enterococcal infections

Wang

Kortsalioudaki

Heath

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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“…Among human milk-fed infants, mixtures of probiotic and not single-strain products were effective in reducing late onset sepsis as well. 10 In diarrheal patients of our study, nutritional status was also observed and the results showed that those 25 group A and 23 group B patients who had normal nutritional status had no dehydration as well. Similarly, moderate malnutrition noted in 12 group A and 15 group B patients had some dehydration.…”

Section: Assessment Of Dehydrationmentioning

confidence: 50%

Clinical and demographic profile of paediatric patients presenting with acute diarrhea

Shah

Sareen

Goyal

2020

Int J Contemp Pediatr

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Background: Diarrhea is a public health problem globally, being the 2nd leading cause of death in children under 5 years. Dehydration as well as malnutrition are also serious consequences of diarrhea. This study was carried out with an aim to focus on the clinical and demographic profile of diarrheal patients of pediatric age.Methods: Infants and children aged 6 months to 5 years were analysed for age and gender distribution, chief complaints, feeding practices, nutritional status and assessment of dehydration; from January 2018 to June 2019 in the Department of Pediatrics of a Tertiary Care Teaching Hospital.Results: Total 150 patients were analysed. Almost 50.67% group A and 41.34% group B patients belonged to toddlerhood. Male preponderance was also noted. Along with diarrhea, vomiting was noted in 22 group A and 21 group B and fever in 19 group A and 29 group B patients. Approximately 41-45% patients had no malnutrition and 55-60% had no dehydration in both the study groups.Conclusions: There is lack of awareness regarding dog bite and its management among the rural people fever and vomiting were most frequently associated with diarrhea. A little less than half of the study participants had some-dehydration. Nearly half of the patients belonged to toddler age group. Majority of the patients were exclusively breast-fed for six months.

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“…L. acidophilus/B. infantis may require the complex composition of human milk to exert a growth-promoting effect and to stabilize gut immunity in order to prevent translocation sepsis [6,7,33]. Human milk includes endogenous probiotics, prebiotic carbohydrates, stem cells, and a concert of bioactive human milk factors (e.g., S100 A8/9 [34]) that have direct or indirect effects on the vulnerable host-gut microbiota interplay [11].…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

et al. 2020

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Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth. Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models. Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82–4.35; p < 0.001) but not in the F group (effect size B = −0.06; 95% CI: −3.05–0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59–0.79; p < 0.001). Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

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Probiotics Prevent Late-Onset Sepsis in Human Milk-Fed, Very Low Birth Weight Preterm Infants: Systematic Review and Meta-Analysis

Cited by 93 publications

References 77 publications

Epidemiology and healthcare factors associated with neonatal enterococcal infections

Epidemiology and healthcare factors associated with neonatal enterococcal infections

Clinical and demographic profile of paediatric patients presenting with acute diarrhea

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

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