Necrotising enterocolitis and mortality in preterm infants after introduction of probiotics: a quasi-experimental study

Samuels, Noor; Graaf, Rob van de; Been, Jasper V; Jonge, Rogier C. J. de; Hanff, Lidwien M.; Wijnen, René; Kornelisse, René F.; Reiss, Irwin K M; Vermeulen, Marijn J.

doi:10.1038/srep31643

Cited by 49 publications

(41 citation statements)

References 41 publications

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“…Samuels et al . () reported that introduction of probiotics was associated with reduced adjusted odds for ‘NEC or sepsis or death’ only in exclusively breastmilk‐fed infants [OR: 0.43, 95% CI: 0.21–0.93, P = 0.03]. Our non‐RCT supports the benefits of probiotics in breastmilk‐fed preterm infants (Patole et al ., ).…”

Section: Evidence Supporting Benefits Of Probiotics In Preterm Infantsasupporting

confidence: 79%

“…(). Probiotics in breastmilk vs. formula‐fed infants: Many believe that probiotics are not required if the infant is fed breast milk – the ideal food provided by nature that contains many bioactive elements including probiotics, human milk oligosaccharides, and lactoferrin. The results of two non‐RCTs are important in this context (Repa et al ., ; Samuels et al ., ). Repa et al .…”

Section: Evidence Supporting Benefits Of Probiotics In Preterm Infantsamentioning

confidence: 97%

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Probiotics for preterm infants – time to end all controversies

Athalye-Jape

Patole

2019

Microbial Biotechnology

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Summary Mortality, necrotising enterocolitis ( NEC ), late onset sepsis ( LOS ) and feeding intolerance are significant issues for very preterm (< 32 weeks) and extremely preterm (< 28 weeks) infants. The complications of ≥ Stage II NEC [e.g. Resection of the gangrenous gut, survival with intestinal failure, recurrent infections, prolonged hospital stay, and long‐term neurodevelopmental impairment ( NDI )] impose a significant health burden. LOS also carries significant burden including long‐term NDI due to adverse effects of inflammation on the preterm brain during the critical phase of development. Frequent stopping of feeds due to feeding intolerance is a significant iatrogenic contributor to postnatal growth failure in extremely preterm infants. Over 25 systematic reviews and meta‐analyses of RCT s (~12 000 participants) have reported that probiotics significantly reduce the risk of all‐cause mortality, NEC ≥ Stage II , LOS and feeding intolerance in preterm infants. Systematic reviews and meta‐analysis of non‐ RCT s have also shown that the benefits after adopting probiotics as a standard prophylaxis for preterm infants are similar to those reported in RCT s. No intervention comes close to probiotics when it comes to significant reduction in death, NEC , LOS and feeding intolerance at a cost of less than a dollar a day irrespective of the setting and baseline incidence of NEC . The common controversies that are preventing the rapid uptake of probiotics for preterm infants are addressed in this paper.

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Section: Evidence Supporting Benefits Of Probiotics In Preterm Infantsasupporting

confidence: 79%

Section: Evidence Supporting Benefits Of Probiotics In Preterm Infantsamentioning

confidence: 97%

Probiotics for preterm infants – time to end all controversies

Athalye-Jape

Patole

2019

Microbial Biotechnology

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“…It is also important to mention that in preterm infants, despite the evidence of a certain level of risk, the administration of probiotics decreases the risk of NEC and decreases its mortality 38,39 .…”

Section: Casei L Plantarum L Acidophilus L Delbruecki Subsp Bumentioning

confidence: 99%

Inocuidad, prevención y riesgos de los probióticos

Brunser

2017

Rev. chil. pediatr.

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Probiotics have been defined as live microorganisms which, when ingested in adequate numbers, confer health benefits to the host. They are currently consumed without any age restrictions and adverse effects such as sepsis, a marker of the risk of invasion of the bloodstream, are extremely infrequent. However, some health professionals express doubts about probiotics being truly innocuous. This review discusses the incidence of sepsis secondary to probiotics use, mainly lactobacilli and bifidobacteria, evaluated through molecular biology or classic culture techniques, showing that sepsis in large numbers of individuals along decennia is extremely low, of the order of 0,02% en some centers or as low as 1 case/million population in France. These data are important considering the use different species and strains of these microorganisms. Few studies which have reported other adverse effects but many of these have problems with their design that cast doubt about the validity of their results. On the contrary, it has been shown that probiotic microorganisms exert positive stimulatory effects on innate and acquired immunity, with decrease of the manifestations of atopy and eczema. These positive effects are further evidenced by the beneficial effects of many species of probiotics in preventing necrotizing enterocolitis in patients as functionally labile as premature-born babies.

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“…5–7 Preventive strategies, such as probiotics, holding feeds during transfusions, truncating antibiotic use during the first week, and providing exclusive human milk feedings have not eradicated the disease, and in some cases their efficacy has been refuted by randomized control trials. 8–12 For example, in a recent UK study, Costeloe et al 13 reported no effect of probiotics in a very large cohort, and a meta-analysis by Samuel et al 14 found no additional value of probiotics for infants who received breast milk. We clearly need better-defined mechanistic interventions to prevent NEC.…”

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confidence: 99%