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Published on: January 27, 2019
Probiotics for prevention of necrotizing enterocolitis and sepsis in preterm infants
Nicholas D Embleton1, Stefan Zalewski, Janet E Berrington
1aInstitute of Health and Society, Newcastle University bNeonatal Unit, Newcastle Hospitals NHS Foundation Trust cInstitute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Insights
Probiotics may reduce necrotizing enterocolitis risk in preterm infants, but varied products and trial limitations complicate findings. More research is needed to confirm benefits and ensure product quality for neonatal care.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Microbiome Research
Background:
- Necrotizing enterocolitis (NEC) is a critical concern in preterm infants.
- Prophylactic probiotic use for NEC prevention is debated.
- Recent studies offer new insights into probiotic efficacy and safety.
Purpose of the Study:
- To review recent studies on prophylactic probiotics for NEC prevention in neonates.
- To analyze the current evidence, including meta-analyses and large trials.
- To discuss the complexities and uncertainties surrounding probiotic use in preterm infants.
Main Methods:
- Systematic review of recent (1-2 years) clinical trials and meta-analyses.
- Analysis of studies using diverse probiotic species and administration protocols.
- Evaluation of trial methodologies and population heterogeneity.
Main Results:
- Meta-analyses suggest probiotics reduce NEC risk.
- Methodological limitations exist in published trials.
- The largest trial contradicts meta-analysis conclusions, highlighting inconsistencies.
- Different probiotic species show variable effects in preterm infants.
- Commercial product variability and quality control are significant concerns.
Conclusions:
- Probiotics show potential for NEC prevention but require further investigation.
- Species-specific effects and optimal administration protocols remain unclear.
- Robust quality control and head-to-head trials are essential for clinical guidance.
Purpose Of Review:
Few areas in neonatal medicine have generated as much discussion and controversy as the use of prophylactic probiotics for the prevention of necrotizing enterocolitis. We summarize recent studies from the last 1-2 years.
Recent Findings:
Systematic reviews show that probiotics reduce the risk of necrotizing enterocolitis but there are methodological limitations to all the published trials, and the largest trial to date is at odds with the conclusions of the meta-analyses. Trials have used a range of commercially available products with differing species, and administered these at different times to heterogeneous populations of preterm babies. Although there is strong evidence to show that 'probiotics' are likely to represent a major advance for neonatal care, it is increasingly clear that not all species have beneficial effects in preterm infants. This makes interpretation of meta-analyses complex, and the determination of a single 'risk reduction' potentially flawed.
Summary:
Despite current uncertainties, it is difficult for clinicians to ignore the current data, and increasing numbers now use commercially available products. It remains a matter of concern that many products lack the robust quality control most clinicians and parents would consider important for use in vulnerable populations. Head-to-head trials are needed.
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