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Necrotising enterocolitis and mortality in preterm infants after introduction of probiotics: a quasi-experimental
Noor Samuels1, Rob van de Graaf1, Jasper V Been1
1Erasmus MC, Department of Paediatrics, division of Neonatology, Rotterdam, 3000 CB, The Netherlands.
Insights
Routine probiotics did not significantly reduce necrotising enterocolitis (NEC) or death in preterm infants. However, probiotics showed a potential benefit for exclusively breastfed infants regarding NEC, sepsis, or death.
Area of Science:
- Neonatalogy
- Gastroenterology
- Microbiome research
Background:
- Necrotising enterocolitis (NEC) is a serious condition in preterm infants.
- Previous studies on probiotics for NEC prevention yielded conflicting results.
- Existing research often lacked adjustments for temporal trends and feeding methods.
Purpose of the Study:
- To investigate the association between routine probiotic use and the combined outcome of NEC or death in preterm infants.
- To assess the impact of introducing Lactobacillus acidophilus and Bifidobacterium bifidum (Infloran®) on NEC incidence.
- To explore potential modifications of probiotic effects by feeding type.
Main Methods:
- A comparative study of preterm infants (<32 weeks gestation or <1500g birth weight) before and after probiotic introduction.
- Utilized interrupted time series logistic regression models.
- Adjusted for confounders, feeding type, seasonality, and temporal trends.
Main Results:
- No significant difference in the primary outcome 'NEC or death' was observed between the pre- and post-probiotic periods.
- Overall NEC incidence decreased, but this trend was not statistically significant after adjustments.
- A significant reduction in adjusted odds for 'NEC or sepsis or death' was found exclusively in breastmilk-fed infants (OR 0.43).
Conclusions:
- Routine probiotic administration was not associated with a reduction in 'NEC or death' in the overall preterm infant population.
- Feeding type appears to be a significant modifier of probiotic efficacy.
- Further research may be needed to clarify the role of probiotics in specific infant subgroups, such as those exclusively breastfed.
Abstract:
Evidence on the clinical effectiveness of probiotics in the prevention of necrotising enterocolitis (NEC) in preterm infants is conflicting and cohort studies lacked adjustment for time trend and feeding type. This study investigated the association between the introduction of routine probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum; Infloran(®)) on the primary outcome 'NEC or death'. Preterm infants (gestational age <32 weeks or birth weight <1500 gram) admitted before (Jan 2008-Sep 2012; n = 1288) and after (Oct 2012-Dec 2014; n = 673) introduction of probiotics were compared. Interrupted time series logistic regression models were adjusted for confounders, effect modification by feeding type, seasonality and underlying temporal trends. Unadjusted and adjusted analyses showed no difference in 'NEC or death' between the two periods. The overall incidence of NEC declined from 7.8% to 5.1% (OR 0.63, 95% CI 0.42-0.93, p = 0.02), which was not statistically significant in the adjusted models. Introduction of probiotics was associated with a reduced adjusted odds for 'NEC or sepsis or death' in exclusively breastmilk-fed infants (OR 0.43, 95% CI 0.21-0.93, p = 0.03) only. We conclude that introduction of probiotics was not associated with a reduction in 'NEC or death' and that type of feeding seems to modify the effects of probiotics.
