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Probiotics and necrotizing enterocolitis
Paul Fleming1,2, Nigel J Hall3,4, Simon Eaton5
1Homerton University Hospital, London, UK.
Insights
Probiotics may reduce necrotizing enterocolitis (NEC) in premature infants, but more research is needed. Current evidence is insufficient to recommend universal probiotic use due to trial heterogeneity and underrepresentation of high-risk infants.
Area of Science:
- Neonatal research
- Gastroenterology
- Microbiome studies
Background:
- Necrotizing enterocolitis (NEC) is a serious condition in premature infants.
- Probiotics are being investigated as a preventive measure for NEC.
- Existing meta-analyses suggest potential benefits but have limitations.
Purpose of the Study:
- To evaluate the efficacy and safety of probiotics for NEC prevention in premature infants.
- To address the controversy surrounding routine probiotic administration.
- To explore the mechanisms of probiotic action in NEC prevention.
Main Methods:
- Review of heterogeneous randomized controlled trials.
- Analysis of data on probiotic use in premature infants, including those with low birth weight (<1000 g).
- Examination of existing meta-analyses and their limitations.
Main Results:
- Combined data suggest probiotics may decrease NEC incidence.
- High-risk infants (<1000 g) are under-represented in trials.
- Evidence for efficacy and safety of universal prophylactic administration is inadequate.
- Mechanisms of probiotic action remain unclear, though experimental evidence is emerging.
Conclusions:
- Routine probiotic administration for NEC prevention in premature infants is controversial.
- Further research is required to establish clear guidelines.
- Understanding probiotic mechanisms may lead to novel prevention strategies.
Abstract:
Probiotics for the prevention of necrotizing enterocolitis have attracted a huge interest. Combined data from heterogeneous randomised controlled trials suggest that probiotics may decrease the incidence of NEC. However, the individual studies use a variety of probiotic products, and the group at greatest risk of NEC, i.e., those with a birth weight of less than 1000 g, is relatively under-represented in these trials so we do not have adequate evidence of either efficacy or safety to recommend universal prophylactic administration of probiotics to premature infants. These problems have polarized neonatologists, with some taking the view that it is unethical not to universally administer probiotics to premature infants, whereas others regard the meta-analyses as flawed and that there is insufficient evidence to recommend routine probiotic administration. Another problem is that the mechanism by which probiotics might act is not clear, although some experimental evidence is starting to accumulate. This may allow development of surrogate endpoints of effectiveness, refinement of probiotic regimes, or even development of pharmacological agents that may act through the same mechanism. Hence, although routine probiotic administration is controversial, studies of probiotic effects may ultimately lead us to effective means to prevent this devastating disease.
