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

Lau, Christine; Chamberlain, Ronald S.

doi:10.1016/j.jpedsurg.2015.05.008

Cited by 84 publications

(70 citation statements)

References 55 publications

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“…Our results are in contrast to those of the latest meta-analyses 33,34 (Alfaleh 2014 Cochrane review, 19 studies, N = 5338; Lau 2015, 17 studies, N = 5215) that did not find statistically significant benefit of probiotic supplementation in reducing LOS in preterm infants. The most likely reason for the difference between our meta-analysis and the previous ones is the sample size.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 84%

“…Our systematic review has 4078 more preterm infants than the previous ones. 33,34 Our results are also in contrast to the recently concluded 2 large multicenter trials (ProPrems, 68 N = 1099; PiPS, 67 N = 1310). In the ProPrems trial, there was significant decrease in LOS in infants born at ≥28 weeks' gestation (probiotics, 5.5%; placebo, 10.8%; P = .01); however, in the overall group born at <32 weeks' gestation, there was no such benefit (probiotics, 13 Participants: Preterm infants <34 wk (2 groups: extremely preterm, 27-30 + 6 wk, and very preterm, 31-33 + 6 wk) Intervention: Bacillus clausii (2.4 × 10 9 spores/d) vs placebo Duration of supplementation: Commenced d5 in asymptomatic and d10 in symptomatic neonates and continued for 6 wk, discharge, death, or occurrence of LOS, whichever was earlier Sample size: 244 (study: extremely preterm 61, very preterm 62) vs (placebo: 121) Type of milk: EBM/PDHM; Type of delivery: CD: extremely preterm, 66% vs 59% and very preterm, 58% vs 60% Primary outcome: Incidence of defi nite and probable LOS in neonates <34 wk LOS: extremely preterm 6/61 (9.8%) vs 8/59 (13.6%) and very preterm 2/62 (3%) vs 3/62 (4.8%) 37. is the small sample size, because to detect a statistically significant benefit for an RR reduction of 20%, a sample size of ~4500 (2250 in each arm) would be needed.…”

Section: Discussioncontrasting

confidence: 84%

“…23 Animal research and in vitro studies 24 have shown that probiotics improve gut barrier function, 25,26 inhibit gut colonization with pathogenic bacteria, 27 improve colonization with healthy commensals, 28,29 protect from enteropathogenic infection through production of acetate, 30 enhance innate immunity, 31 and increase maturation of the enteric nervous system, 32 all of which have the potential to decrease the risk of LOS in preterm infants. However, the recent Cochrane Review 33 (2014) 34 (2015) also reported similar results on LOS (RR, 0.919; 95% CI, 0.823-1.027; P = .137; 17 randomized controlled trials [RCTs], N = 5215).…”

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confidence: 82%

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Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis

et al. 2016

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CONTEXT: Late-onset sepsis (LOS) is a major cause of mortality and morbidity in preterm infants. Despite various preventive measures, its incidence continues to remain high, hence the urgent need for additional approaches. One such potential strategy is supplementation with probiotics. The updated Cochrane Review (2014) did not find benefits of probiotics in reducing the risk of LOS in preterm infants (19 studies, N = 5338). Currently there are >30 randomized controlled trials (RCTs) of probiotics in preterm infants that have reported on LOS. OBJECTIVES:To conduct a systematic review including all relevant RCTs.DATA SOURCES: PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in June and August 2015.STUDY SELECTION: RCTs comparing probiotics versus placebo/no probiotic were included. DATA EXTRACTION:Relevant data were extracted independently by 3 reviewers. RESULTS:Pooled results from 37 RCTs (N = 9416) using fixed effects model meta analysis showed that probiotics significantly decreased the risk of LOS (675/4852 [13.9%] vs 744/4564 [16.3%]; relative risk, 0.86; 95% confidence interval, 0.78-0.94; P = .0007; I 2 = 35%; number needed to treat, 44). The results were significant even after excluding studies with high risk of bias. CONCLUSIONS: Probiotic supplementation reduces the risk of LOS in preterm infants.a Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; b Neonatal ICU, Princess Margaret Hospital for Children, Perth, Western Australia; c Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia; d Neonatal ICU, Nepean Hospital, Kingswood, NSW, Australia; and e Sydney Medical School, Nepean, University of Sydney, Australia Dr Rao conceptualized and designed the study, performed an independent literature search, selected studies for inclusion, extracted and interpreted data, assessed risk of bias of included studies, handled the meta-analysis software, and wrote the fi rst and fi nal drafts of the manuscript; Dr Athalye-Jape performed an independent literature search, selected studies for inclusion, contacted authors for additional information where necessary, extracted and interpreted the data, checked the data entered by S.C.R. on the meta-analysis software, assessed the risk of bias of included studies, and helped with the fi rst and the fi nal draft of the manuscript; Dr Deshpande performed an independent literature search, selected studies for inclusion, verifi ed the extracted data, assessed risk of bias, interpreted data, and oversaw translation of manuscripts in the Chinese language; Dr Simmer supervised the project, interpreted the data, and supervised the fi rst and fi nal versions of the manuscript; Dr Patole supervised the project, acted as referee author in case of d...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 84%

Section: Discussioncontrasting

confidence: 84%

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confidence: 82%

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Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis

et al. 2016

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“…Among bacteria, Lactobacilli and Bifidobacteria are the main genera of probiotics which have been implicated in beneficial outcomes. Probiotics can exert health benefits for treatment and prevention of gastrointestinal disorders, such as impairment of colonic transit, enteric infections and post-antibiotic syndrome, reduction of recurrence of Clostridium difficile associated diarrhea, prevention of necrotizing enterocolitis and colorectal cancer, and prevention and treatment of inflammatory bowel diseases [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%