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Published on: January 27, 2019
Probiotic supplementation in neonates with congenital gastrointestinal surgical conditions: a pilot randomised
Shripada Rao1,2,3, Meera Esvaran4, Liwei Chen5
1Neonatal Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia. shripada.rao@health.wa.gov.au.
Insights
Probiotic supplementation significantly reduced gut dysbiosis in neonates with congenital gastrointestinal surgical conditions. This intervention increased beneficial Bifidobacteriaceae abundance, offering a promising therapeutic approach.
Area of Science:
- Neonatal gut microbiome research
- Probiotic therapeutic applications
- Gastrointestinal surgery outcomes
Background:
- Gut dysbiosis is a concern in neonates with congenital gastrointestinal surgical conditions (CGISC).
- Altering the gut microbiota may improve outcomes for these vulnerable infants.
Purpose of the Study:
- To evaluate the efficacy of probiotic supplementation in attenuating gut dysbiosis in neonates with CGISC.
- To assess the impact of probiotics on the relative abundance of potentially pathogenic bacteria.
Main Methods:
- A randomized controlled trial involving 61 neonates with CGISC.
- Daily administration of a triple-strain bifidobacterial probiotic or placebo until discharge.
- 16S rRNA gene sequencing of stool microbiota at multiple time points.
Main Results:
- The probiotic group showed a significantly lower relative abundance of potentially pathogenic bacterial families at T3 (p=0.04).
- Relative abundance of Bifidobacteriaceae was significantly higher in the probiotic group at T3 (p<0.001).
- These effects were observed irrespective of the mode of delivery.
Conclusions:
- Probiotic supplementation effectively attenuated gut dysbiosis in neonates with CGISC.
- This intervention promotes a healthier gut microbial profile in this patient population.
- Findings support further investigation in larger multicenter trials.
Objective:
To evaluate whether probiotic supplementation attenuates gut-dysbiosis in neonates with congenital gastrointestinal surgical conditions (CGISC).
Methods:
Sixty-one neonates (≥35 weeks gestation) with CGISC were randomised to receive daily supplementation with a triple-strain bifidobacterial probiotic (n = 30) or placebo (n = 31) until discharge. Stool microbiota was analysed using 16S ribosomal RNA gene sequencing on samples collected before (T1), 1 week (T2), and 2 weeks (T3) after supplementation and before discharge (T4). The primary outcome was the sum of the relative abundance of potentially pathogenic families of Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Pseudomonaceae, Staphylococcaeae, Streptococcaceae, and Yersiniaceae at T3.
Results:
The median gestational age [38 weeks (IQR: 37.1-38.9)] was similar in both groups. The probiotic group had lower rates of caesarean deliveries (40% versus 70%, p = 0.02). The relative abundance of potentially pathogenic families was lower in the probiotic group compared to placebo at T3 [(median: 50.4 (IQR: 26.6-67.6) versus 67.1 (IQR: 50.9-96.2); p = 0.04). Relative abundance of Bifidobacteriaceae was higher in the probiotic group at T3 [(median: 39.8 (IQR: 24.9-52.1) versus 0.03 (IQR 0.02-2.1); p < 0.001). Stratified analysis continued to show a higher abundance of Bifidobacteriaceae in the probiotic group, irrespective of the mode of delivery.
Conclusions:
Probiotic supplementation attenuated gut dysbiosis in neonates with CGISC.
Trial Registration:
http://www.anzctr.org.au (ACTRN12617001401347).
Impact:
Probiotic supplementation attenuates gut dysbiosis and improves stool short-chain fatty acid levels in neonates with congenital gastrointestinal surgical conditions. This is the second pilot RCT of probiotic supplementation in neonates with congenital gastrointestinal conditions. These findings will pave the way for conducting multicentre RCTs in this area.
