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The availability of probiotics and donor human milk is associated with improved survival in very preterm infants
Janet Sharpe1, Mandy Way2, Pieter J Koorts1
1Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia.
Insights
The introduction of pasteurized donor human milk and probiotics significantly reduced mortality in very preterm infants. While necrotizing enterocolitis and sepsis incidence also decreased, these findings were not statistically significant.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Microbiome Research
Background:
- Very preterm infants (<32 weeks gestation or <1500g birthweight) are at high risk for mortality, necrotizing enterocolitis (NEC), and sepsis.
- Standard care for these infants often involves specialized feeding strategies to mitigate these risks.
Purpose of the Study:
- To evaluate the impact of introducing pasteurized donor human milk and probiotics on mortality, NEC, and sepsis in very preterm infants.
- To determine if these interventions are associated with improved survival and reduced incidence of serious complications.
Main Methods:
- A retrospective analysis comparing two cohorts of very preterm infants: one before and one after the implementation of pasteurized donor human milk and probiotic supplementation.
- Statistical analysis included univariate and multivariate logistic regression to assess the impact of interventions on primary and secondary outcomes.
Main Results:
- Mortality rates were significantly lower in the post-intervention cohort (2.4%) compared to the pre-intervention cohort (7.6%) (P<0.001).
- Incidence of sepsis was also significantly reduced post-intervention (3.5% vs. 6.2%, P=0.028).
- While NEC and gastrointestinal perforation rates were lower in the post-intervention group, these differences did not reach statistical significance.
Conclusions:
- Pasteurized donor human milk and probiotics are associated with a significant reduction in mortality for very preterm infants.
- Further research may be needed to confirm the statistically significant impact on NEC and sepsis rates.
Background:
To determine whether the introduction of pasteurized donor human milk and probiotics for infants born < 32 weeks gestational age or < 1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis.
Methods:
We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donor human milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression.
Results:
There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P < 0.001) and incidence of sepsis (6.2 vs. 3.5%, P = 0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P = 0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P = 0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16-0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant.
Conclusion:
The availability of probiotics and pasteurised donor human milk is associated with a reduction in mortality in very preterm infants.
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