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Published on: January 27, 2019
Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis
Isadora Beghetti1, Davide Panizza1, Jacopo Lenzi2
1Neonatal Intensive Care Unit, AOU Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.
Insights
Probiotics may prevent necrotizing enterocolitis (NEC) in preterm infants. Bifidobacterium lactis Bb-12/B94 showed reduced NEC risk, with greater effect in exclusively human milk-fed infants.
Area of Science:
- Neonatal medicine
- Microbiology
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a significant concern in preterm infants.
- Emerging evidence suggests probiotics may play a role in NEC prevention.
Purpose of the Study:
- To systematically review and perform a network meta-analysis of randomized controlled trials (RCTs) investigating probiotics for NEC prevention in preterm infants.
- To analyze the differential effect of probiotic interventions based on infant feeding type (exclusively human milk vs. formula).
Main Methods:
- A systematic review and network meta-analysis adhering to PRISMA guidelines.
- Inclusion of 51 RCTs involving 10,664 preterm infants and 29 probiotic interventions.
- Subgroup analysis comparing exclusively human milk-fed infants with those receiving formula.
Main Results:
- Lactobacillus acidophilus LB demonstrated a promising reduction in NEC risk overall (OR 0.03).
- Bifidobacterium lactis Bb-12/B94 was associated with reduced risk of NEC stage ≥2 in both feeding groups.
- A greater effect size for B. lactis Bb-12/B94 was observed in exclusively human milk-fed infants (OR 0.04) compared to formula-fed infants (OR 0.32).
Conclusions:
- Bifidobacterium lactis Bb-12/B94 may reduce NEC risk in preterm infants, with varying efficacy based on feeding type.
- The findings highlight a potentially greater benefit in infants fed exclusively human milk.
- Further research is warranted due to the limited number of trials and population sizes for most probiotic strains.
Background:
Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants.
Methods:
A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed.
Results:
Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00-0.21). The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01-0.49 vs. OR 0.32; 95% CrIs 0.10-0.36).
Conclusions:
B. lactis Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.
