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Published on: January 27, 2019
Probiotic Supplementation in Preterm Infants Does Not Affect the Risk of Bronchopulmonary Dysplasia: A Meta-Analysis
Eduardo Villamor-Martínez1, Maria Pierro2, Giacomo Cavallaro3
1Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6202 AZ Maastricht, The Netherlands. eduardo.villamormartinez@mumc.nl.
Insights
Probiotic supplements help prevent necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants. However, this study found no evidence that probiotics reduce the risk of bronchopulmonary dysplasia (BPD).
Area of Science:
- Neonatalogy
- Gastroenterology
- Pulmonology
Background:
- Probiotic supplementation is known to reduce necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants.
- The impact of probiotics on other neonatal complications, such as bronchopulmonary dysplasia (BPD), remains unclear.
Purpose of the Study:
- To systematically review and perform a meta-analysis evaluating the effect of probiotic supplementation on the risk of developing BPD in preterm infants.
- To determine if the known protective effects of probiotics against NEC and LOS extend to BPD prevention.
Main Methods:
- A systematic review and meta-analysis of fifteen randomized controlled trials involving 4782 preterm infants.
- Included studies assessed outcomes related to NEC, LOS, and BPD (defined as oxygen dependency at 28 days or 36 weeks postmenstrual age).
Main Results:
- Meta-analysis confirmed a significant reduction in NEC (RR 0.52) and a near-significant reduction in LOS (RR 0.82).
- Probiotic use did not significantly affect the risk of BPD, with RR of 1.01 (oxygen at 28 days) and 1.07 (oxygen at 36 weeks).
- Meta-regression showed no association between the risk reduction of NEC/LOS and the risk of BPD.
Conclusions:
- Probiotic supplementation effectively reduces NEC and LOS in preterm infants.
- The prevention of NEC and LOS by probiotics does not appear to influence the risk of developing BPD in this population.
Abstract:
Probiotic supplementation reduces the risk of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants, but it remains to be determined whether this reduction translates into a reduction of other complications. We conducted a systematic review and meta-analysis to evaluate the possible role of probiotics in altering the risk of bronchopulmonary dysplasia (BPD). Fifteen randomized controlled trials (4782 infants; probiotics: 2406) were included. None of the included studies assessed BPD as the primary outcome. Meta-analysis confirmed a significant reduction of NEC (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.33 to 0.81, p = 0.004; random effects model), and an almost significant reduction of LOS (RR 0.82, 95% CI 0.65 to 1.03, p = 0.084). In contrast, meta-analysis could not demonstrate a significant effect of probiotics on BPD, defined either as oxygen dependency at 28 days of life (RR 1.01, 95% CI 0.91 to 1.11, p = 0.900, 6 studies) or at 36 weeks of postmenstrual age (RR 1.07, 95% CI 0.96 to 1.20, p = 0.203, 12 studies). Meta-regression did not show any significant association between the RR for NEC or LOS and the RR for BPD. In conclusion, our results suggest that NEC and LOS prevention by probiotics does not affect the risk of developing BPD in preterm infants.
