Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants

Sharif, Sahar; Meader, Nick; Oddie, Sam; Rojas-Reyes, María Ximena; McGuire, William

doi:10.1002/14651858.cd005496.pub5

Cited by 145 publications

(209 citation statements)

References 154 publications

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“…The abundance of species and their diversity is, other than by gestational age, also influenced the use of (intrapartum) antibiotics, method of feeding, and mode of delivery. The presence and abundance of Clostridium perfringens , which produces alpha toxin, and Bacteroides dorei in the meconium were associated with NEC, suggesting that factors during pregnancy, delivery, and the first moments of life may contribute to the formation of an NEC-associated microbiota [ 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…The most recent Cochrane review [ 9 ] performed a meta-analysis comparing different probiotic preparations ( Table 2 ). The reviewed population included 10,812 preterm infants distributed over 56 trials with an average gestational age of 28-32 weeks and an average birth weight of 1,000–1,200 g. The overall conclusion was that supplementation with probiotics reduced the risk of NEC (relative risk [RR], 0.54; 95% confidence interval [CI], 0.54–0.65) with the combination of Bacillus and Lactobacillus spp.…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity meta-analyses of 16 trials (4,597 infants) at low risk of bias did not show any effect on mortality or infection. Evidence was assessed as low certainty because of the limitations in the trial design and the presence of funnel plot asymmetry consistent with publication bias [ 9 ].…”

Section: Resultsmentioning

confidence: 99%

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Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis

Seghesio

Geyter

Vandenplas

2021

Pediatr Gastroenterol Hepatol Nutr

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Necrotizing enterocolitis (NEC) is a disease with high morbidity and mortality that occurs mainly in premature born infants. The pathophysiologic mechanisms indicate that gastrointestinal dysbiosis is a major risk factor. We searched for relevant articles published in PubMed and Google Scholar in the English language up to October 2020. Articles were extracted using subject headings and keywords of interest to the topic. Interesting references in included articles were also considered. Network meta-analysis suggests the preventive efficacy of Bifidobacterium and Lactobacillus spp., but even more for mixtures of Bifidobacterium , Streptococcus , and Bifidobacterium , and Streptococcus spp. However, studies comparing face-to-face different strains are lacking. Moreover, differences in inclusion criteria, dosage strains, and primary outcomes in most trials are major obstacles to providing evidence-based conclusions. Although adverse effects have not been reported in clinical trials, case series of adverse outcomes, mainly septicemia, have been published. Consequently, systematic administration of probiotic bacteria to prevent NEC is still debated in literature. The risk-benefit ratio depends on the incidence of NEC in a neonatal intensive care unit, and evidence has shown that preventive measures excluding probiotic administration can result in a decrease in NEC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis

Seghesio

Geyter

Vandenplas

2021

Pediatr Gastroenterol Hepatol Nutr

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“…These are significant results, although the reviewers express concern about the quality of some of the studies and call for larger randomised controlled trials (RCTS). [16] There is lesser evidence demonstrating probiotics can be used to lessen irritable bowel syndrome. The majority of these supportive data have been collected in adult populations.…”

Section: Introductionmentioning

confidence: 99%

Probiotics: Popping the Prevalence and Parental Perspective

Parry¹,

Tuthill²

2021

AJP

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The aim of this project was to evaluate parental knowledge and opinions on the use of probiotics in children, specifically comparing those attending an allergy or gastroenterology clinic with parents of other paediatric patients. A survey containing nine items was administered to a convenience sample of parents in the inpatient and outpatient departments at the Children's Hospital for Wales. The questions were asked face to face by one observer; answers were recorded anonymously on a tablet computer using the online survey tool KwikSurveys. A total of 304 parents completed the survey. Overall, 53.9% of parents knew what probiotics were, 75.3% thought that they could improve a child's health and 53.6% had given their child probiotics. In the cohort attending allergy or gastroenterology clinics, 64.2% had given their child probiotics, compared with 50.2% of the remaining participants (OR 1.78; 95% CI 1.01, 3.12). Healthcare professionals were 13% more likely to recommend the use of a probiotic to a parent in this cohort. In conclusion, awareness and knowledge of probiotics was reasonable among parents, and most thought that they could improve a child's health. Parents were more likely to give their child probiotics if they attended an allergy or gastroenterology clinic.

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“…Examples include the use of prophylactic peroral aminoglycoside which reduces NEC incidence but is not considered feasible due to the risk of antimicrobial resistance and other potential side effects [11]. Prophylactic probiotic supplementation appears to reduce NEC incidence with few side effects [12] and is routinely used in preterm infants, although the optimal combination of bacterial strains, dose and timing is unknown.…”

Section: Introductionmentioning

confidence: 99%

Donor-dependent Fecal Microbiota Transplantation Efficacy Against Necrotizing Enterocolitis in Preterm Pigs

Hui¹,

Vestergaard²,

Deng³

et al. 2020

Preprint

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BackgroundFecal microbiota transplantation (FMT) has shown high cure rates against recurrent Clostridioides difficile infection regardless of donor microbiota characteristics, whereas the clinical response of FMT in inflammatory bowel disease appears to be donor-dependent. We recently showed that FMT from healthy suckling piglet donors to newborn preterm piglets decreased the risk of necrotizing enterocolitis (NEC), a serious gastrointestinal disease of preterm infants, but could not replicate this finding in a follow-up study using phenotypically similar donors. This gave us the opportunity to directly investigate the microbiota dynamics of clinically efficient FMT. In this experiment, preterm piglets (n=38) were randomly allocated to receive control saline or FMT from inferior (FMT1) or superior donors (FMT2) by rectal administration. All animals were fed infant formula for four days to induce NEC-like lesions before necropsy and gut pathological evaluation. Donor and recipient colonic microbiotas were analyzed by 16S rRNA gene amplicon sequencing and shotgun metagenomics.ResultsAlthough the two donor microbiotas closely resembled one another, only FMT2 recipients had improved body growth and lower intestinal permeability relative to control, and were protected against NEC. Both FMT groups had shifted colon microbiota composition relative to CON, with increased lactobacilli relative abundance, but FMT2 recipients had a higher lactobacilli abundance relative to FMT1. Limosilactobacillus reuteri and Lactobacillus crispatus strains of FMT recipients showed high phylogenetic similarity with their respective donors, indicating successful engraftment. Further, NEC severity was positively associated with Clostridoides difficile, Clostridium perfringens and Enterococcus faecium abundance, while Lmb. reuteri and Lb. crispatus negatively correlated with diarrhea severity. Genome-resolved analysis indicated a higher gut replication rate of lactobacilli in FMT2 recipients, and identified specific glycosaminoglycan-degrading Bacteroides in the superior donor.ConclusionsFMT efficacy against NEC is donor-dependent, and introduced lactobacilli manifest strain-level differences with respect to colonizing recipients. Using shotgun metagenomics, we traced the engrafted strains back from donors and identified donor-specific microbes of potential importance. This may accelerate our understanding of optimal donor selection for clinical FMT.

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Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants

Abstract: Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants (Review)

Cited by 145 publications

References 154 publications

Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis

Probiotics in the Prevention and Treatment of Necrotizing Enterocolitis

Probiotics: Popping the Prevalence and Parental Perspective

Donor-dependent Fecal Microbiota Transplantation Efficacy Against Necrotizing Enterocolitis in Preterm Pigs

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