To study the role of probiotics in the prevention of necrotizing enterocolitis in preterm neonates

Abstract

Background: Necrotizing enterocolitis is defined as an inflammatory bowel necrosis in premature infants and is major cause of morbidity and mortality in neonatal intensive care units throughout the world. We aim to study the role of probiotics in reducing incidence and severity of necrotizing enterocolitis in preterm neonates ≤34 weeks and its role on secondary outcomes like mortality, time to reach full feeds, daily weight gain, days of hospitalization and effect on nosocomial infections.Methods: This study was a prospective randomized controlled interventional trial conducted in SGRDIMSAR, Amritsar. A sample size of 150 was selected. 75 were randomized to test group and 75 to control group by simple random sampling.Results: The incidence of NEC was significantly lower in the test group compared with the control group (1 of 75 neonates vs 12 of 75 neonates; p=0.001). The severity of NEC, nosocomial sepsis and mean duration of hospital stay was significantly lower in the test group. Daily weight gain was significantly higher in the test group. There was no significant difference in mean age of onset of NEC, mortality and mean age to reach full feeds in two groups.Conclusions: Incidence and severity of NEC was less in the probiotic group. Daily weight gain was better, nosocomial sepsis and mean duration of hospital stay were less in the probiotic group.

Role of probiotics in clinical course and outcome of preterm neonates

“…In our present study, the incidence of NEC was significantly lower in the test group compared with the control group (1 of 30 neonates versus 4 of 30 neonates; p<0.001). Similar observations were seen in studies by Lin et al, Angela, Bin-Nun et al, Lin et al, Janvier et al and Khurana et al 8,13,14,17,18,20 However studies conducted by Dani et al, Costalos et al and Manzoni et al found a lower incidence of NEC in the probiotic group, but this did not reach statistical significance. 7,15,16…”

Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

“…After excluding duplicates, 648 records were screened, of which 576 were excluded due to not meeting the inclusion criteria. Finally, 51 studies assessing the effects of 29 different probiotic interventions were eligible for inclusion in the systematic review and primary NMA [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 <...>…”

“…Only 18 studies reported NEC according to feeding type during the study period: ten studies reported NEC in exclusively HM-fed infants [ 29 , 33 , 40 , 51 , 53 , 62 , 64 , 70 , 74 , 76 ], either the mother’s own (MOM) or donor human milk (DHM), five studies included exclusively formula-fed infants [ 34 , 36 , 55 , 69 , 77 ], one study included infants who received HM plus FM [ 46 ] and two studies reported outcome according to different feeding types [ 37 , 57 ]. Separate data according to type of feeding were provided by e-mail for 13 of these studies [ 28 , 39 , 44 , 45 , 48 , 56 , 58 , 63 , 66 , 67 , 68 , 72 , 75 ].…”

“…B. lactis Bb-12 OR B94, L. acidophilus and L. reuteri DSM17938 respectively showed the three best SUCRA values, followed by the multi-genus group ( Figure 5 A). However, according to the forest plot of relative effect sizes compared to placebo ( Figure 5 B), only B. lactis Bb-12 OR B94, based on one trial [ 39 ] with 91 infants, L. reuteri DSM17938, based on two trials [ 67 , 76 ] with 194 infants, and the multi-genus group, based on eight trials [ 29 , 33 , 44 , 51 , 62 , 63 , 64 , 68 ] with 1040 infants, were associated with a reduced risk of stage ≥ 2 NEC in exclusively HM-fed preterm infants.…”

“…The OR distributions of B. bifidum + B. infantis + B. longum + L. acidophilus (based on one RCT [ 64 ] with 186 infants), B. longum R00175 + L. helveticus R0052 + L. rhamnosus R0011 + Sa. boulardii CNCM-I-1079 (based on two RCTs [ 29 , 68 ] with 254 infants) and B. infantis ATCC15697 + L. acidophilus ATCC4356 (based on one RCT [ 51 ] with 367 infants) indicated that these treatments were associated with a reduced risk of stage ≥ 2 NEC in exclusively HM-fed preterm infants.…”