Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics

Abstract

ObjectiveTo compare rates of necrotising enterocolitis (NEC), late-onset sepsis, and mortality in 5-year epochs before and after implementation of routine daily multistrain probiotics administration in high-risk neonates.DesignSingle-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017.SettingLevel 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK.PatientsPreterm neonates at high risk of NEC: admitted to NICU within 3 days of birth at <32 weeks’ gestation or at 32–36 weeks’ gestation and of birth weight <1500 g.InterventionPrior to 1 January 2013 probiotics were not used. Thereafter, dual-species Lactobacillus acidophilus and Bifidobacterium bifidum combination probiotics were routinely administered daily to high-risk neonates; from April 2016 triple-species probiotics (L. acidophilus, B. bifidum, and B. longum subspecies infantis) were used.Main outcome measuresIncidence of NEC (modified Bell’s stage 2a or greater), late-onset sepsis, and mortality.ResultsRates of NEC fell from 7.5% (35/469 neonates) in the pre-implementation epoch to 3.1% (16/513 neonates) in the routine probiotics epoch (adjusted sub-hazard ratio=0.44, 95% CI 0.23 to 0.85, p=0.014). The more than halving of NEC rates after probiotics introduction was independent of any measured covariates, including breast milk feeding rates. Cases of late-onset sepsis fell from 106/469 (22.6%) to 59/513 (11.5%) (p<0.0001), and there was no episode of sepsis due to Lactobacillus or Bifidobacterium. All-cause mortality also fell in the routine probiotics epoch, from 67/469 (14.3%) to 47/513 (9.2%), although this was not statistically significant after multivariable adjustment (adjusted sub-hazard ratio=0.74, 95% CI 0.49 to 1.12, p=0.155).ConclusionsAdministration of multispecies Lactobacillus and Bifidobacterium probiotics has been associated with a significantly decreased risk of NEC and late-onset sepsis in our neonatal unit, and no safety issues. Our data are consistent with routine use of Lactobacillus and Bifidobacterium combination probiotics having a beneficial effect on NEC prevention in very preterm neonates.

Probiotic Supplementation during the Perinatal and Infant Period: Effects on gut Dysbiosis and Disease

“…The most recent studies support the use of Lactobacillus and Bifidobacterium combination probiotics as most beneficial for preventing NEC in very preterm neonates [160].…”

Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study

“…A recent clinical audit at the Norfolk and Norwich University Hospital NICU found rates of NEC fell from 7.5% to 3.1%, and rates of LOS fell from 22.6% to 11.5% when comparing the 5 years before and 5 years after the initiation of routine probiotic use with a combined Bifidobacterium and Lactobacillus supplement. 21 Building on these important clinical observations, we aimed to explore the gut microbiota composition and fecal metabolome in these preterm infants receiving routine probiotic supplementation compared to preterm infants from NICUs not using probiotic supplementation.…”

Preterm infants harbour diverse Klebsiella populations, including atypical species that encode and produce an array of antimicrobial resistance- and virulence-associated factors

“…Critically, colonization of these at-risk infants with potentially pathogenic taxa, in concert with an unstable microbiome, and immaturity of their GI tract and immune system, is thought to contribute to nosocomial infections such as late-onset sepsis (LOS) or necrotizing enterocolitis (NEC) [6][7][8][9][10][11][12].…”