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Effect of single versus multistrain probiotic in extremely preterm infants: a randomised trial

Gayatri Athalye-Jape1, Meera Esvaran2, Sanjay Patole3

  • 1Neonatology directorate, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia gayatri.jape@health.wa.gov.au.

BMJ Open Gastroenterology
|February 21, 2022
PubMed

Insights

Single-strain (SS) and triple-strain (TS) probiotics similarly improved feeding outcomes in extremely preterm (EP) infants. Both probiotic types effectively reduced gut dysbiosis, indicating potential benefits for infant gut health.

Area of Science:

  • Neonatal Medicine
  • Microbiome Research
  • Gastroenterology

Background:

  • Multistrain probiotics are suggested to offer greater benefits than single-strain probiotics for preterm infants.
  • Extremely preterm (EP) infants (<28 weeks' gestational age) have unique nutritional and gut microbiome needs.
  • Understanding the impact of different probiotic formulations on EP infant gut development is crucial.

Purpose of the Study:

  • To compare the efficacy of single-strain (SS) versus triple-strain (TS) probiotic supplementation in extremely preterm (EP) infants.
  • To assess the impact of probiotic supplementation on time to full feed (TFF) and gut microbiota composition.
  • To evaluate changes in short-chain fatty acid (SCFA) levels in response to probiotic intervention.

Main Methods:

  • Randomized controlled trial involving 173 EP infants allocated to SS or TS probiotic groups.
  • Probiotic supplementation was administered from birth until 37 weeks' corrected gestational age.
  • Faecal microbiota and SCFA analysis using 16S rRNA gene sequencing and other methods at baseline and after 3 weeks of supplementation.

Main Results:

  • Time to full feed (TFF) was comparable between SS and TS probiotic groups (median 11 vs 10 days, p=0.92).
  • Both SS and TS probiotics significantly increased faecal propionate and butyrate levels.
  • Probiotic supplementation altered gut microbiota, increasing beneficial Actinobacteria and decreasing potentially harmful Proteobacteria, Firmicutes, and Bacteroidetes compared to a placebo group.

Conclusions:

  • Single-strain and triple-strain probiotics demonstrate similar efficacy in achieving full feeds in extremely preterm infants.
  • Both probiotic types effectively modulate the gut microbiota, reducing dysbiosis markers like lower Gammaproteobacteria.
  • Further research is needed to determine the long-term clinical significance of increased propionate and butyrate levels.
Abstract

Keywords:
infant/neonatal nutritionintestinal microbiologyneonatal gutprobiotics

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