Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis

Denkel, Luisa A.; Schwab, Frank J.; Garten, Lars; Geffers, Christine; Gastmeier, Petra; Piening, Brar

doi:10.1371/journal.pone.0158136

Cited by 53 publications

(48 citation statements)

References 41 publications

(80 reference statements)

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“…Pooled analyses of 4 observational studies [50,51,53,59] showed a statistically significant 51% reduction of NEC and 46% reduction of mortality. Recently, a large observational multicentre study conducted by Denkel et al [71] demonstrated that the routine use of dual-strain probiotics (Infloran) in German neonatal wards significantly reduced the risk of NEC, overall mortality, and late-onset sepsis. These effects were even more pronounced in the subgroup analysis of preterm infants with birth weights below 1,000 g. In the meta-analysis of RCTs where a combination of more than 2 probiotics was used, a statistically significant effect in preventing NEC and mortality was seen.…”

Section: Discussionmentioning

confidence: 99%

The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants

Dermyshi

Wang²,

Yan³

et al. 2017

Neonatology

16,439

137

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Background: Over the last few years, probiotics have been one of the most studied interventions in neonatal medicine. Objectives: The aim of this work was to analyse all studies (randomized controlled trials, RCTs, and observational studies) assessing the use of probiotics in very low birth weight (VLBW) preterm infants. Search Methods: A systematic literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science. The data from RCTs and observational studies were pooled and analysed separately. Selection Criteria: RCTs and observational studies that enrolled VLBW infants with enteral administration of probiotics were considered. Extracted study data included probiotic characteristics and at least 1 clinical outcome (necrotizing enterocolitis [NEC], late-onset sepsis or all-cause mortality). Data Collection and Analysis: Forty-four studies were eligible for our review: 30 RCTs and 14 observational studies. Severe NEC rates (stage II or more) and all-cause mortality were reduced among the probiotic groups in both the RCTs (RR 0.57, 95% CI 0.47-0.70, and RR 0.77, 95% CI 0.65-0.92, respectively) and the observational studies (RR 0.51, 95% CI 0.37-0.70, and RR 0.71, 95% CI 0.62-0.81, respectively). Furthermore, there was a 12% reduction in the risk of sepsis in RCTs and a 19% reduction in observational studies. The meta-analysis of observational studies showed a reduction in the risk of NEC in extremely low birth weight infants. However, this was not statistically significant. Conclusions: This meta-analysis of RCT and observational studies found that the use of probiotics was beneficial for the prevention of severe NEC, late-onset sepsis, and all-cause mortality in VLBW infants.

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Section: Discussionmentioning

confidence: 99%

The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants

Dermyshi

Wang²,

Yan³

et al. 2017

Neonatology

16,439

137

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“…Furthermore, putting complicated statistics aside, significant benefits for all outcomes were noted in infants ‘colonised’ with the probiotic (Deshpande et al ., ). Inadequate data on extremely preterm infants: Considering that RCT data is available from ˜2000 extremely preterm infants, and Denkel et al . () have reported data on 4600 extremely preterm infants, quoting inadequate data as the reason for not using probiotics in this (most deserving) population is incorrect. In fact the benefits of routine probiotic supplementation were as dramatic as those in very preterm infants in the report by Denkel et al .…”

Section: Evidence Supporting Benefits Of Probiotics In Preterm Infantsamentioning

confidence: 99%

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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“…Another recent meta-analysis did not show a significant beneficial effect of probiotics on sepsis in 771 ELBW infants included 3. This demands further studies with adequate power on the use of probiotics in infants born <1000 g. Almost at the same time, we published a multicentre time series analysis supporting the beneficial effects of dual-strain probiotics on NEC, overall-mortality and nosocomial bloodstream infections (BSI) in preterm infants 4. Beyond that, we performed a subgroup analyses with 4683 ELBW infants.…”

mentioning

confidence: 99%

Dual-strain probiotics reduce NEC, mortality and neonatal bloodstream infections among extremely low birthweight infants

Denkel

Schwab

Garten

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis

Cited by 53 publications

References 41 publications

The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants

The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants

Probiotics for preterm infants – time to end all controversies

Dual-strain probiotics reduce NEC, mortality and neonatal bloodstream infections among extremely low birthweight infants

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