Prevention of Necrotizing Enterocolitis in Very Low Birth Weight Preterm Infants with Probiotics: A Systematic Review and Meta-analysis (original) (raw)
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Jornal de Pediatria (Versão em Português), 2013
Objective: To elucidate the benefits of using probiotics in the prevention of necrotizing enterocolitis (NEC) and its complications in preterm newborns. Method: This was a systematic review of randomized controlled trials, which included studies retrieved from three databases (MEDLINE, Embase, and LILACS), using a combination of the terms (necrotizing enterocolitis) AND (probiotics). Results: 11 randomized trials were included, totaling 2,887 patients, 1,431 in the probiotic group and 1,456 in the control group. There was a reduction in the incidence of NEC (NNT = 25), overall death (NNT = 34), and neonatal sepsis (NNT = 34) in the probiotic group compared to the control group. Patients that received probiotic supplementation had lower food reintroduction time (p < 0.001) and hospitalization time (p < 0.001) when compared to those not receiving probiotics. There was no difference in mortality caused by NEC. Conclusion: In premature newborns, the use of probiotics is effective as a prophylaxis for NEC and its complications.
Clinical Nutrition, 2012
Background & aims: Probiotics have been suggested to prevent severe necrotizing enterocolitis (NEC) and decrease mortality in preterm infants. The aim of this paper was to systematically analyze the level of evidence (LoE) of published controlled randomized trials (RCTs) on probiotics in preterm infants. Methods: Literature searches were made up to November 2010. LoE of recommendations based on single trials or meta-analyses were scored following the Oxford Center for Evidence based Medicine approach (1a e meta-analyses of 1b LoE studies; 1b e well designed RCT; 2a e meta-analyses which include 2b LoE studies; 2b -lesser quality RCT). Results: Fifteen trials were included (Two 1b LoE trials and thirteen 2b LoE trials). Methodological assessment revealed considerable heterogeneity. Some probiotics may be beneficial in relation to reduction of severe NEC (2b LoE) and reduction of mortality (2b LoE). Probiotics do not accelerate feeding advancement (1b and 2b LoE). There was no convincing benefit with regard to prevention of sepsis (1b and 2b LoE). Conclusion: There is insufficient evidence to recommend routine probiotics. However, there is encouraging data (2b LoE) which justifies the further investigation regarding the efficacy and safety of specific probiotics in circumstances of high local incidence of severe NEC.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2016
OBJECTIVE To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis (NEC) in preterm very low birth weight (VLBW) infants. STUDY DESIGN Arandomized double blind controlled trial. PLACE AND DURATION OF STUDY The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet Bangladesh, from July 2012 to June 2015. METHODOLOGY Preterm (28 - 33 weeks gestation) VLBW (birth weight 1000 - 1499 g) neonates were enrolled. The study group was fed with probiotics once daily with breast milk from first feeding, and the control group with only breast milk without the addition of probiotics. Both the groups received other standard care. The primary outcome was the development of NEC (stage II and III), categorized by modified Bell's classification. RESULTS In 108 neonates, development of NEC was significantly lower in the study group than that of control group [1 (1.9%) vs. 6 (11.5%); p=0.044]. Age of achievement of full oral feeding...
Efficacy of probiotics to prevent necrotizing enterocolitis in low birth weight preterm neonates
The Professional Medical Journal
Objective: To compare the efficacy of probiotics in prevention of necrotizing enterocolitis (NEC) among low birth weight (LBW) preterm neonates. Study Design: Randomized controlled trial. Setting: Department of Pediatric Medicine, Unit-II, Services Hospital, Lahore. Period: September 2019 to February 2020. Material and Methods: A total of 260 LBW preterm neonates were enrolled. All the neonates were allocated to 2 groups with equal number of cases (130 in each group). Group-A was given probiotics whereas placebo was administered in Group-B. All the cases were admitted and follow ups were made up until 7th day. Occurrence of NEC was recorded among both groups. Results: Out of a total of 260 LBW preterm neonates, 142 (54.6%) were male and118 (45.4%) female. Overall, mean age was noted to be 1.48+0.50 days. Table-I shows that there was no statistical difference among neonates of both study groups in terms of age, gestational age and birth weight (p>0.05). Five (3.8%) neonates in Gro...
British Journal of Nutrition, 2017
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....
Advances in Nutrition: An International Review Journal
Probiotics are increasingly used as a supplement to prevent adverse health outcomes in preterm infants. We conducted a systematic review, meta-analysis, and subgroup analysis of findings from randomized controlled trials (RCTs) to assess the magnitude of the effect of the probiotics on health outcomes among very-low-birth-weight (VLBW) infants. Relevant articles from January 2003 to June 2017 were selected from a broad range of databases, including Medline, PubMed, Scopus, and Embase. Studies were included if they used an RCT design, involved a VLBW infant (birthweight <1500 g or gestational age <32 wk) population, included a probiotic intervention group, measured necrotizing enterocolitis (NEC) as a primary outcome, and measured sepsis, mortality, length of hospital stay, weight gain, and intraventricular hemorrhage (IVH) as additional outcomes. The initial database search yielded 132 potentially relevant articles and 32 (n = 8998 infants) RCTs were included in the final metaanalysis. Subgroup analysis was used to evaluate the effects of the moderators on the outcome variables. In the probiotics group, it was found that NEC was reduced by 37% (95% CI: 0.51%, 0.78%), sepsis by 37% (95% CI: 0.72%, 0.97%), mortality by 20% (95% CI: 0.67%, 0.95%), and length of hospital stay by 3.77 d (95% CI: 25.94, 21.60 d). These findings were all significant when compared with the control group. There was inconsistent use of strain types among some of the studies. The results indicate that probiotic consumption can significantly reduce the risk of developing medical complications associated with NEC and sepsis, reduce mortality and length of hospital stay, and promote weight gain in VLBW infants. Probiotics are more effective when taken in breast milk and formula form, consumed for <6 wk, administered with a dosage of <10 9 CFU/d, and include multiple strains. Probiotics are not effective in reducing the incidence of IVH in VLBW infants. Adv Nutr 2017;8:749-63. , and their values were included in the analysis.
Probiotic Therapy for Prevention of Necrotizing Enterocolitis in Preterm Infants – A Review
Journal of Nutritional Health & Food Science, 2018
Purpose: Preterm infants are prone to systemic infections due to increased intestinal permeability to potentially pathogens resulting from immature intestinal function, frequent use of broad-spectrum antibiotics, delay in initiating enteral feeding, infection control procedures and sterilization of milk. Very Low Birth Weight infants, particularly Extremely Low Birth Weight infants are at higher risk due to abnormal pattern of colonization, which may contribute to the pathogenesis of neonatal Necrotizing Enterocolitis (NEC). Dietary intervention through probiotic supplementation is widely adopted for the prophylaxis of NEC and nosocomial infections throughout the world. Design/Methodology/Approach: This review paper is based upon systematic review of randomized controlled trials, metaanalyses, research papers and books related to the short and longterm administration of single or mixed probiotic cultures for the prevention of NEC only in preterm infants. Clinical trials and cohort studies concerning manipulation of the intestinal microbiota in premature infants are also included. Evidence based data published in the English language retrieved from three databases Pub Med, Science Direct and Cochrane Reviews, published in The Cochrane Library from 2000-2016, using a combination of key words like necrotizing enterocolitis, probiotics and preterm infants have been considered. Findings: All probiotic strains are not equally efficacious for preventing NEC and application of probiotic combinations may be advantageous. Due to heterogeneity of probiotic formulations exclusive administration of probiotics in premature infants is not recommended and should be introduced along with breast milk as routine clinical practice for neonatal health care. Originality/Value: Probiotic foods have been found effective in modulating gastrointestinal flora to prevent NEC but safety aspects must be evaluated prior to consideration of probiotic therapy for preterm infants and neonates.
Nutrients
Background: Necrotizing enterocolitis (NEC) is a multifactorial disease, causing inflammation of the bowel. The exact root of NEC is still unknown, but a low weight and gestational age at birth are known causes. Furthermore, antibiotic use and abnormal bacterial colonization of the premature gut are possible causes. Premature neonates often experience feeding intolerances that disrupts the nutritional intake, leading to poor growth and neurodevelopmental impairment. Methods: We conducted a double-blind, placebo-controlled, randomized clinical trial to investigate the effect of a multi-strain probiotic formulation (LabinicTM) on the incidence and severity of NEC and feeding intolerances in preterm neonates. Results: There were five neonates in the placebo group who developed NEC (Stage 1A–3B), compared to no neonates in the probiotic group. Further, the use of probiotics showed a statistically significant reduction in the development of feeding intolerances, p < 0.001. Conclusion:...
Effectiveness of Oral Probiotics in Prevention of Necrotizing Enterocolitis in Preterm Infants
Journal of Pharmaceutical Research International
Objective: To determine the efficacy of probiotics in the prevention of necrotizing enterocolitis in preterm infants. Materials And Methods: This randomized controlled trial was conducted at the paediatric department of CMH Muzaffarabad AJK. All preterm bottle and NG-fed neonates with an age of more than 24 hours and both genders were included. All the study subjects were divided into two groups randomly as group-A and group-B. Group-A was given probiotics (named Bifidobacterium prophylactically, hiflora, or gutcare, one sachet per day), while in Group-B probiotics were not given. All the cases were taken under observation. If they needed any critical or intensive care, they were excluded from the study and other treatments were given as per hospital protocol. Patients were followed for 7 days. Efficacy in both groups was measured in terms of no occurrence of NEC during one week. All related data was collected on a study proforma. Results: The average age of the neonates in the pro...
Frontiers in Pediatrics, 2021
Background: The administration of live microbiota (probiotic) via enteral route to preterm infants facilitates intestinal colonization with beneficial bacteria, resulting in competitive inhibition of the growth of pathogenic bacteria preventing gut microbiome dysbiosis. This dysbiosis is linked to the pathogenesis of necrotizing enterocolitis (NEC), an acquired multi-factorial intestinal disease characterized by microbial invasion of the gut mucosa, particularly affecting preterm infants. Probiotic prophylaxis reduces NEC; however, variations in strain-specific probiotic effects, differences in administration protocols, and synergistic interactions with the use of combination strains have all led to challenges in selecting the optimal probiotic for clinical use.Aim: To compare any differences in NEC rates, feeding outcomes, co-morbidities in preterm infants receiving single or two-strain probiotics over a 4-year period. The two-strain probiotic prophylaxis was sequentially switched ...