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Prophylactic Probiotics for Preterm Infants: A Systematic Review and Meta-Analysis of Observational Studies
Rie Olsen1, Gorm Greisen, Morten Schrøder
1Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Insights
Probiotic supplementation significantly reduces necrotizing enterocolitis (NEC) and mortality in preterm infants. This meta-analysis of observational studies confirms the benefits of probiotics for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Preventive Medicine
Background:
- Necrotizing enterocolitis (NEC) is a leading cause of death in preterm infants.
- Probiotics have shown promise in preventing NEC, supported by randomized controlled trial (RCT) meta-analyses.
- This study focuses on observational data to confirm probiotic efficacy in preterm neonates.
Purpose of the Study:
- To assess the effects of prophylactic probiotics in preterm infants.
- To review and confirm the efficacy of probiotics in preventing NEC and other outcomes in preterm neonates based on observational studies.
Main Methods:
- A comprehensive meta-analysis of observational studies was conducted.
- Searches included PubMed, EMBASE, CENTRAL, and clinicaltrials.gov, along with reference lists.
- Included studies involved preterm infants (<37 weeks gestational age) receiving probiotics, measuring outcomes like NEC, mortality, sepsis, and development.
Main Results:
- The meta-analysis included 12 studies with 10,800 preterm neonates.
- Probiotic use significantly decreased NEC incidence (RR = 0.55) and all-cause mortality (RR = 0.72).
- No significant difference in sepsis rates was observed between probiotic and control groups (RR = 0.86).
Conclusions:
- Probiotic supplementation effectively reduces the risk of NEC and mortality in preterm infants.
- The observed effect sizes align with findings from RCT meta-analyses.
- Further research is needed to determine optimal probiotic strains, dosages, and administration timing.
Background:
Necrotizing enterocolitis (NEC) is a major morbidity and cause of mortality in preterm neonates. Probiotics seem to have a beneficial role in preventing NEC, which is confirmed in meta-analyses of randomized controlled trials (RCTs). We therefore aimed to review and confirm the efficacy of probiotics in preterm neonates obtained in observational studies.
Objective:
To assess the effects of prophylactic probiotics in preterm infants.
Methods:
A meta-analysis was performed searching PubMed, EMBASE, CENTRAL (the Cochrane Library) and www.clinicaltrials.gov. Reference lists of reviews of RCTs were also searched. Included studies were observational studies that enrolled preterm infants <37 weeks of gestational age. Trials were included if they administered any probiotics and measured at least one clinical outcome (e.g. NEC, all-cause mortality, sepsis or long-term development scores). Two authors extracted characteristics and outcomes from included studies. The Newcastle-Ottawa Scale was used for quality assessment. A random-effects meta-analysis model was used, and heterogeneity was assessed by the I2 test.
Results:
We included 12 studies with 10,800 premature neonates (5,144 receiving prophylactic probiotics and 5,656 controls). The meta-analysis showed a significantly decreased incidence of NEC (risk ratio, RR = 0.55, 95% confidence interval, 95% CI, 0.39-0.78; p = 0.0006) and mortality (RR = 0.72, 95% CI, 0.61-0.85; p < 0.0001). Sepsis did not differ significantly between the two groups (RR = 0.86, 95% CI, 0.74-1.00; p = 0.05).
Conclusions:
Probiotic supplementation reduces the risk of NEC and mortality in preterm infants. The effect sizes are similar to findings in meta-analyses of RCTs. However, the optimal strain, dose and timing need further investigation.
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