Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

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.