The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The dramatic effect sizes, tight confidence intervals, extremely low P values, and overall evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available.

No abstract

The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.

Survivors of stage II or higher NEC are at risk for long-term neurodevelopmental impairment, especially if they require surgery for the illness.

CONTEXT: Late-onset sepsis (LOS) is a major cause of mortality and morbidity in preterm infants. Despite various preventive measures, its incidence continues to remain high, hence the urgent need for additional approaches. One such potential strategy is supplementation with probiotics. The updated Cochrane Review (2014) did not find benefits of probiotics in reducing the risk of LOS in preterm infants (19 studies, N = 5338). Currently there are >30 randomized controlled trials (RCTs) of probiotics in preterm infants that have reported on LOS. OBJECTIVES:To conduct a systematic review including all relevant RCTs.DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in June and August 2015.STUDY SELECTION: RCTs comparing probiotics versus placebo/no probiotic were included. DATA EXTRACTION:Relevant data were extracted independently by 3 reviewers. RESULTS:Pooled results from 37 RCTs (N = 9416) using fixed effects model meta analysis showed that probiotics significantly decreased the risk of LOS (675/4852 [13.9%] vs 744/4564 [16.3%]; relative risk, 0.86; 95% confidence interval, 0.78-0.94; P = .0007; I 2 = 35%; number needed to treat, 44). The results were significant even after excluding studies with high risk of bias. CONCLUSIONS: Probiotic supplementation reduces the risk of LOS in preterm infants.a Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; b Neonatal ICU, Princess Margaret Hospital for Children, Perth, Western Australia; c Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia; d Neonatal ICU, Nepean Hospital, Kingswood, NSW, Australia; and e Sydney Medical School, Nepean, University of Sydney, Australia Dr Rao conceptualized and designed the study, performed an independent literature search, selected studies for inclusion, extracted and interpreted data, assessed risk of bias of included studies, handled the meta-analysis software, and wrote the fi rst and fi nal drafts of the manuscript; Dr Athalye-Jape performed an independent literature search, selected studies for inclusion, contacted authors for additional information where necessary, extracted and interpreted the data, checked the data entered by S.C.R. on the meta-analysis software, assessed the risk of bias of included studies, and helped with the fi rst and the fi nal draft of the manuscript; Dr Deshpande performed an independent literature search, selected studies for inclusion, verifi ed the extracted data, assessed risk of bias, interpreted data, and oversaw translation of manuscripts in the Chinese language; Dr Simmer supervised the project, interpreted the data, and supervised the fi rst and fi nal versions of the manuscript; Dr Patole supervised the project, acted as referee author in case of d...

No abstract

Long chain polyunsaturated fatty acid supplementation in infants born at term.

BackgroundCurrent evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates.AimTo develop evidence-based guidelines for probiotic supplementation in preterm neonates.MethodsTo develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review.ResultsIn this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research.ConclusionWe hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics.