Probiotics for preterm infants - time to end all controversies

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Gayatri Athalye-Jape1,2, Sanjay Patole1,2

  • 1Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, WA, Australia.

Microbial Biotechnology
|January 15, 2019
PubMed

Insights

Probiotics significantly reduce mortality, necrotising enterocolitis (NEC), and late onset sepsis (LOS) in preterm infants. This cost-effective intervention offers substantial benefits for infant health and survival.

Area of Science:

  • Neonatalogy
  • Pediatric Gastroenterology
  • Microbiome Research

Background:

  • Preterm infants (<32 weeks) face high risks of mortality, necrotising enterocolitis (NEC), late onset sepsis (LOS), and feeding intolerance.
  • Complications of NEC and LOS, including neurodevelopmental impairment (NDI), impose a significant health and economic burden.
  • Feeding intolerance contributes to postnatal growth failure in extremely preterm infants.

Purpose of the Study:

  • To evaluate the efficacy of probiotics in reducing mortality, NEC, LOS, and feeding intolerance in preterm infants.
  • To address controversies hindering the widespread adoption of probiotics for preterm infant care.
  • To highlight the cost-effectiveness and significant benefits of probiotic prophylaxis.

Main Methods:

  • Systematic reviews and meta-analyses of randomized controlled trials (RCTs) involving approximately 12,000 preterm infants.
  • Analysis of non-randomized controlled trials (non-RCTs) to confirm benefits in real-world settings.
  • Assessment of the cost-effectiveness of probiotics as a standard prophylactic measure.

Main Results:

  • Probiotics significantly reduce the risk of all-cause mortality, NEC (≥ Stage II), LOS, and feeding intolerance in preterm infants.
  • Benefits observed in RCTs are corroborated by systematic reviews of non-RCTs.
  • Probiotic prophylaxis is highly cost-effective, costing less than a dollar per day.

Conclusions:

  • Probiotics are a highly effective and cost-effective intervention for improving outcomes in preterm infants.
  • Widespread adoption of probiotics as standard prophylaxis is recommended to reduce mortality, NEC, LOS, and feeding intolerance.
  • Further research and addressing current controversies can accelerate the uptake of this beneficial intervention.

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