Implementation of a probiotic protocol to reduce rates of necrotizing enterocolitis

Sekhon, Mehtab K.; Grubb, Peter H.; Newman, Michael G.; Yoder, Bradley A.

doi:10.1038/s41372-019-0443-5

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…HM is known to protect against NEC 2–4 . Following the introduction of exclusive PDHM and probiotics use in our NICU, the baseline NEC was already low at ∼2% in ELBW infants 15 . We, therefore, did not expect that introducing EHMD would have yielded further significant reduction in NEC.…”

Section: Discussionmentioning

confidence: 93%

“…An extensively hydrolyzed liquid protein fortifier (Liquid Protein Fortifier; Abbott Nutrition, Abbott Park, IL), a fat‐containing modular (Microlipids; Nestlé Health Science, Bridgewater, NJ), and Neosure (Similac Abbott Nutrition, Abbott Park, IL) were also added in the setting of inadequate growth. All ELBW infants received Ultimate Flora Baby Probiotics (RenewLife, Palm Harbor, FL), which reduced our unit's incidence rate of NEC Bell stage ≥2 from 7% to 2% 15 …”

Section: Methodsmentioning

confidence: 99%

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Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

et al. 2021

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Problem: Extremely low‐birth‐weight (ELBW) infants require fortification of human milk (HM) to prevent growth failure. Bovine milk–based fortifiers (BOV‐f) may be associated with feeding intolerance and necrotizing enterocolitis. Evidence suggests that an exclusive HM diet (EHMD) using HM‐based fortifier (HM‐f) may improve these outcomes. Intervention: EHMD was introduced as a quality improvement project to improve feeding tolerance in ELBW infants. Method: Implementation included establishing EHMD feeding protocol and growth monitoring. We compared infants receiving HM with BOV‐f (n = 49) with infants receiving an EHMD (n = 15). The primary outcome was a reduction of no oral intake days due to feeding intolerance. Results: The EHMD cohort had a more advanced GA (28 vs 26 weeks; P = .03), more males (66.7% vs 42.9%; P = .02), and higher incidence of SGA (40.0% vs 18.4%; P = .16) compared with the HM‐f group. The EHMD cohort had fewer days with no oral intake (2 vs 5; P < .005), which is insignificant when adjusted for small for gestational age (SGA) (P = .26). The EHMD cohort vs. the HM‐f cohort had a significant decrease in weight and length z‐scores from birth to discharge (−1.09 vs −0.26 [P = .002]; −1.76 vs −0.83 [P = .02]). Inadequate weight gain persisted after adjustment for SGA. Interventions were performed to increase caloric intake and institute milk preparation changes. Conclusion: EHMD improved feeding tolerance in our ELBW infants. Observed growth failure might be skewed by SGA prevalence. We highlight that implementation of EHMD requires close growth assessment, especially for SGA infants.

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Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

et al. 2021

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“…Although the study had the advantage of a large sample size, only 21% of the included infants received probiotics, and the study period preceded the introduction of probiotics at BCWH NICU. Retrospective studies by Janvier and colleagues 30 and Sekhon and colleagues 31 also found that probiotics con taining Bifidobacterium and Lactobacillus were associated with a reduced risk of necrotizing enterocolitis from 9.8% to 5.4% (OR 0.51, 95% CI 0.26-0.98) 30 and 7% to 2% 31 (p < 0.001), respectively. However, in the study by Sekhon and colleagues, 31 changes in practice, including the intro duction of a feeding protocol 9 months after the probiotic protocol, could have contributed to decreases in the inci dence of necrotizing enterocolitis.…”

Section: E647mentioning

confidence: 93%

“…Retrospective studies by Janvier and colleagues 30 and Sekhon and colleagues 31 also found that probiotics con taining Bifidobacterium and Lactobacillus were associated with a reduced risk of necrotizing enterocolitis from 9.8% to 5.4% (OR 0.51, 95% CI 0.26-0.98) 30 and 7% to 2% 31 (p < 0.001), respectively. However, in the study by Sekhon and colleagues, 31 changes in practice, including the intro duction of a feeding protocol 9 months after the probiotic protocol, could have contributed to decreases in the inci dence of necrotizing enterocolitis. Other than the intro duction of probiotics, we had minimal changes during the study period to the overall management of infants with very low birth weight.…”

Section: E647mentioning

confidence: 93%

The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight

Que

Oerle

Albersheim

et al. 2021

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The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight Background: Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants. The role of prophylactic probiotics in its prevention is unclear. This study evaluates the effect of routine probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight in the neo natal intensive care unit.Methods: This retrospective cohort study compared infants cared for at a single institution before and after implementation of routine probiotic administration (2014)(2015)(2016)(2017)(2018). Babies born after July 2016 received probiotics containing Bifidobac terium and Lactobacillus daily until 35 weeks corrected gestational age. Baseline charac teristics, necrotizing enterocolitis incidence and severity, infections, mortality, and length of stay were compared between groups.Results: Of the 665 infants included in the study, 310 received probiotics and 355 did not. The 2 groups did not differ with regard to gestational age, birth anthropo metrics, mode of delivery, comorbidities, and type of enteral feed. The incidence of necrotizing enterocolitis (Bell's stage 2 of 3) was similar between groups (4% v. 5%, p = 0.35), as was its severity (p = 0.10). In addition, there were no significant differ ences in mortality and length of stay between the groups. Significantly fewer infants receiving probiotics developed infections (27% v. 34%, p = 0.046), with the rate of urinary tract infections having the largest reduction. Conclusion:The routine use of Bifidobacterium and Lactobacillus probiotics in infants with very low birth weight did not significantly affect the incidence and severity of necrotizing enterocolitis. However, the use of probiotics was associated with fewer overall infections.Contexte : L'entérocolite nécrosante demeure une importante cause de morbidité et de mortalité chez les nourrissons prématurés. Le rôle des probiotiques prophylac tiques pour la prévention de l'entérocolite nécrosante reste à déterminer. Cette étude évalue l'effet de l'administration systématique de probiotiques sur l'incidence et la gravité de l'entérocolite nécrosante chez les nourrissons de très faible poids à la nais sance dans les unités de soins intensifs néonataux.

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“…The human microbiome has now been implicated in several pathologies, including inflammatory bowel disease (IBD; Ott et al, 2004 ), diabetes ( Vatanen et al, 2018 ), and obesity ( Cox et al, 2014 ; de la Cuesta-Zuluaga et al, 2018 ) and therefore represents a broad-range potential therapeutic target. Evidence suggests microbiome-based interventions such as probiotics, may reduce symptoms of irritable bowel syndrome (IBS; Ford et al, 2014 ), antibiotic- associated diarrhea ( Evans et al, 2016 ; Blaabjerg et al, 2017 ), preterm infant mortality rates and necrotizing enterocolitis ( Sekhon et al, 2019 ; Underwood, 2019 ; Liu D. et al, 2020 ). Proposed mechanisms of action include: increases in intestinal barrier function ( Burger-van Paassen et al, 2009 ), production of antimicrobials ( Jones and Versalovic, 2009 ), and interaction with the immune system ( Veckman et al, 2004 ; Smits et al, 2005 ; Kwon et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

Key Technologies for Progressing Discovery of Microbiome-Based Medicines

et al. 2021

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A growing number of experimental and computational approaches are illuminating the “microbial dark matter” and uncovering the integral role of commensal microbes in human health. Through this work, it is now clear that the human microbiome presents great potential as a therapeutic target for a plethora of diseases, including inflammatory bowel disease, diabetes and obesity. The development of more efficacious and targeted treatments relies on identification of causal links between the microbiome and disease; with future progress dependent on effective links between state-of-the-art sequencing approaches, computational analyses and experimental assays. We argue determining causation is essential, which can be attained by generating hypotheses using multi-omic functional analyses and validating these hypotheses in complex, biologically relevant experimental models. In this review we discuss existing analysis and validation methods, and propose best-practice approaches required to enable the next phase of microbiome research.

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Implementation of a probiotic protocol to reduce rates of necrotizing enterocolitis

Cited by 12 publications

References 32 publications

Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight

Key Technologies for Progressing Discovery of Microbiome-Based Medicines

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