A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates

Abstract

Necrotizing enterocolitis (NEC) is one of the most common acquired diseases of the gastrointestinal tract in preterm infants. Some randomized, controlled trials (RCTs) have indicated that probiotics may potentially lower the incidence of NEC and mortality. However, debate still remains about the safety of probiotics and their influence on normal infant growth. We performed this meta-analysis to assess the safety and benefits of probiotic supplementation in preterm infants. We searched in PubMed, Embase, and Cochrane databases for English references, and in Wanfang, VIP, and CNKI databases for Chinese references. Ultimately, 27 RCTs (including 9 Chinese articles) were incorporated into this meta-analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity. A total of 6655 preterm infants, including the probiotic group (n=3298) and the placebo group (n=3357), were eligible for inclusion in this meta-analysis. For Bell stage ≥I and gestational age <37 weeks, risk of NEC incidence was significantly lower in the probiotic group [RR=0.35, 95% confidence interval (CI)=0.27-0.44, P<0.00001]. For Bell stage ≥II or gestational age <34 weeks, there were likewise significant differences between the probiotic and placebo groups concerning NEC incidence (RR=0.34, 95%CI=0.25-0.48, P<0.00001; and RR=0.39, 95%CI=0.27-0.56, P<0.00001). Risk of death was significantly reduced in the probiotic group (RR=0.58, 95%CI=0.46-0.75, P<0.0001). In contrast, there was no significant difference concerning the risk of sepsis (RR=0.94, 95%CI=0.83-1.06, P=0.31). With respect to weight gain and the age at which infants reached full feeds, no significant differences were found between the probiotic and placebo groups (WMD=1.07, 95%CI=−0.21-2.34, P=0.10; and WMD=−1.66, 95%CI=−3.6-0.27, P=0.09). This meta-analysis has shown that, regardless of gestational age and NEC stage, probiotic supplementation could significantly reduce the risk of NEC in preterm infants. Analysis also indicated that such supplementation did not increase the incidence risk of sepsis or of mortality. Finally, the study showed that probiotic supplementation may have no adverse effect on normal feeding and growth.

Probiotic administration can prevent necrotizing enterocolitis in preterm infants: A meta-analysis

“…Yang et al demonstrated a 66% reduction in the risk of NEC in preterm infants with the use of probiotics and a 42% reduction in the risk of mortality, with no significant decrease in the risk of culture-positive sepsis [18]. The most recent Cochrane Review reported a 59% reduction in the risk of NEC and a 34% reduction in the risk of mortality [19].…”

Routine Use of Probiotics in Preterm Infants: Longitudinal Impact on the Microbiome and Metabolome

“…While a single causative agent is unlikely to be identified, dysbiosis of the gut microbiome preceding NEC may be important [7,8,9,10]. …”

Therapeutic Modification of the GI Microbiome

“…38 A meta-analysis of 27 RCTs (N = 6655) of probiotics for preventing necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm infants, found that probiotics supplementation significantly reduced the risk of NEC and death. 39 Findings from animal studies have suggested that probiotics may prevent radiation-induced enteritis, a common and serious complication of radiation treatment for abdominal or pelvic cancer. 40 A review of 14 RCTs provided some evidence for the safe use of a strain of Lactobacillus reuteri for reducing the incidence of acute gastroenteritis in children, and preventing and treating some functional GI disorders, such as colic and regurgitation in infants.…”