Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants

Abstract

The aim of the study was to determine whether routine probiotic supplementation (RPS) with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus +Lactobacillus bifidum is associated with reduced risk of necrotising enterocolitis (NEC)≥Stage II in preterm neonates born at ≤32 weeks' gestation. We conducted a retrospective cohort study on the effect of probiotic supplementation in very low birth weight infants in our neonatal unit by comparing two periods: before and after supplementation. The incidence of NEC≥Stage II, late-onset sepsis and all-cause mortality was compared for an equal period 'before' (Period I) and 'after' (Period II) RPS with LGG or L. acidophillus+L. bifidum. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. The study population was composed of 261 neonates (Period I v. II: 134 v. 127) with comparable gestation duration and birth weights. In <32 weeks, we observed a significant reduction in NEC≥Stage II (11·3 v. 4·8 %), late-onset sepsis (16 v. 10·5 %) and mortality (19·4 v. 2·3 %). The benefits in neonates aged ≤27 weeks did not reach statistical significance. RPS with LGG or L. acidophillus+L. bifidum is associated with a reduced risk of NEC≥Stage II, late-onset sepsis and mortality in preterm neonates born at ≤32 weeks' gestation.

Colonization of preterm gnotobiotic piglets with probioticLactobacillus rhamnosusGG and its interference withSalmonellaTyphimurium

“…Mechanisms of LGG actions against Salmonella are not fully understood, and bacterial interferences use different principles such as inhibition of adhesion and biofilm formation , production of lactic acid and others. Positive effects of LGG against enterocolitis in animal models or in infants have been observed. However, other authors did not confirm such beneficial effects.…”

“…Preterm infants are highly susceptible to dysbiosis and infections that can culminate in early (EOS) or late onset of sepsis (LOS) . Probiotics are microbes that are commonly beneficial to their host and their application influences and supports the establishment of a balanced microbiota . Lactobacillus rhamnosus GG (LGG) belongs to a group of the most frequently used probiotic bacteria applied as a therapeutic agent .…”

The Interaction of the Gut Microbiota with the Mucus Barrier in Health and Disease in Human

“…A role for the mucins in the pathogenesis of NEC is indicated by the depletion of Goblet cells seen in the mucosa of neonates with NEC [ 432 , 433 , 434 ] and this is expected to represent a reduction of MUC2 in the secreted mucus gel. Evidence for abnormal microbiota causing NEC has been proposed [ 435 ] and probiotics ( Bifidobacillus and Lactobacillus strains) have been used in the treatment of the disease [ 436 , 437 , 438 ].…”

Probiotics’ efficacy in paediatric diseases: which is the evidence? A critical review on behalf of the Italian Society of Pediatrics

“…The disappointing results of the PiPs trial caused a major drawback for the use of probiotics in the management of the preterms. In 2017, Uberos conducted a retrospective cohort study evaluating clinical outcomes in VLBW infants, before and after the introduction of routinely probiotics supplementation with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus (L. acidophilus) and Lactobacillus bifidum (L. bifidum) [ 25 ]. The authors observed a significant reduction in NEC ≥ Stage II (11.3 vs 4.8%), LOS (16 vs 10.5%) and mortality (19.4 vs 2.3%) in infants born before 32 weeks of gestational age (WGA), while in neonates aged ≤27 weeks the reduction was not statistically significant [ 25 ].…”

“…In 2017, Uberos conducted a retrospective cohort study evaluating clinical outcomes in VLBW infants, before and after the introduction of routinely probiotics supplementation with Lactobacillus rhamnosus GG (LGG) or Lactobacillus acidophilus (L. acidophilus) and Lactobacillus bifidum (L. bifidum) [ 25 ]. The authors observed a significant reduction in NEC ≥ Stage II (11.3 vs 4.8%), LOS (16 vs 10.5%) and mortality (19.4 vs 2.3%) in infants born before 32 weeks of gestational age (WGA), while in neonates aged ≤27 weeks the reduction was not statistically significant [ 25 ]. In the same year, Aceti et al, on behalf of the Italian Society of Neonatology published another metanalysis of 25 trials on probiotics and LOS: probiotics’ supplementation resulted in a significantly lower incidence of LOS (RR 0.79) [ 26 ].…”