Benefits of probiotics on enteral nutrition in preterm neonates: a systematic review

Athalye-Jape, Gayatri; Deshpande, Girish; Rao, Shripada; Patole, Sanjay

doi:10.3945/ajcn.114.092551

Cited by 81 publications

(70 citation statements)

References 83 publications

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“…We acknowledge that the introduction of probiotics is a potential confounder. It is possible that both by a direct beneficial effect of probiotics on the immune system 31 and by reducing times to full feeds, 32 probiotics may have reduced CLABSI in vulnerable infants by reducing the need for or dwell time of central lines.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

McMullan

Gordon

2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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Section: Discussionmentioning

confidence: 99%

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

McMullan

Gordon

2016

Infect. Control Hosp. Epidemiol.

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“…Pending the results of these studies, other strategies, such as probiotic or prebiotic supplementation to stimulate gastrointestinal maturity and function in preterm VLBW neonates, could also be evaluated [42,43,44,45,46,47]. Systematic reviews of RCTs have shown that prophylactic probiotic supplementation can significantly reduce the risk of NEC ≥ stage II and all-cause mortality while facilitating feed tolerance in preterm VLBW neonates [44,48,49]. Prebiotic oligosaccharides can modulate electrical activity and gastric emptying and may improve feed tolerance in preterm neonates [43,46].…”

Section: Discussionmentioning

confidence: 99%

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

2016

Self Cite

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Background: A delayed passage of meconium is considered as a risk factor for feed intolerance in preterm neonates. Objectives: The aim of this study was to review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates. Methods: A systematic review of randomised controlled trials (RCTs) of different therapeutic agents for meconium evacuation in preterm neonates (gestation <32 weeks and/or birth weight <1,500 g) using the Cochrane systematic review methodology was undertaken. Databases including Google Scholar were searched in January 2016. The primary outcome was the time to reach full feeds (TFF; ≥120 ml/kg feeds with stoppage of parenteral nutrition >24 h). Secondary outcomes included necrotising enterocolitis (NEC), weight at discharge and adverse effects. The results were summarised as per the GRADE guidelines. Results: Six RCTs (2 each of glycerine suppository and enema, 1 normal saline enema and 1 oral osmotic contrast agent; n = 442) with a low or unclear risk of bias were included. The pooled estimate (random effects model) showed no reduction in TFF [mean difference (MD) -0.03, 95% CI -2.47, 2.41, p = 0.98; level of evidence: low]. No differences in NEC [risk ratio (RR) 1.71, 95% CI 0.63, 4.65, p = 0.30; level of evidence: low] and weight at discharge (MD -0.08, 95% CI -0.30, 0.15, p = 0.50; level of evidence: low) were found. The trial assessing oral osmotic contrast agents reported a trend towards a higher incidence of NEC ≥ stage II. There were no other adverse effects. Conclusion: Limited low-quality evidence indicates that prophylactic glycerine suppository, small volume glycerine/normal saline enema or oral osmotic contrast agents to evacuate meconium did not reduce TFF in preterm neonates. Large, well-designed trials are essential to study this clinically significant issue.

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“…Compared with the control group, preterm neonates in the probiotics group had reduced risks of NEC stage ≥2 (20 RCTs, n=5529, RR 0.43, 95% CI 0.33 to 0.56) and all-cause mortality (17 RCTs, n=5112, RR 0.65, 95% CI 0.52 to 0.81), but there was no difference between groups in the risk of nosocomial sepsis (19 RCTs, n=5338, RR 0.91, 95% CI 0.8 to 1.03) 27. Probiotics also reduced the time until full enteral feeding 27 28…”

Section: Clinical Effects Of Probioticsmentioning

confidence: 99%

What are the indications for using probiotics in children?

Szajewska

2015

Arch Dis Child

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The health benefits of probiotics have been the subject of extensive research. Still, some questions are being repeatedly asked: should one use or not use probiotics? If yes, how and when should probiotics be used? The purpose of this review is to summarise current evidence on specific probiotics' efficacy and safety to help healthcare professionals make evidence-based decisions on the indications for using specific probiotic strains or combinations in children. To identify relevant data, searches of MEDLINE and the Cochrane Library databases were performed in July 2015 to locate randomised controlled trials or their meta-analyses published in the last five years. The MEDLINE database also was searched for evidence-based clinical practice guidelines, developed by scientific societies. Considering that probiotics have strain-specific effects, the main focus was on data on individual probiotic strains, not on probiotics in general.

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Benefits of probiotics on enteral nutrition in preterm neonates: a systematic review

Abstract: Probiotics reduced the time to full enteral feeds in preterm neonates. Additional research is necessary to assess the optimal dose, duration, and probiotic strain or strains used specifically for facilitating enteral nutrition in this population.

Cited by 81 publications

References 83 publications

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

What are the indications for using probiotics in children?

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