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Updated: Sep 29, 2025
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Published on: January 27, 2019
Multi-strain probiotics for extremely preterm infants: a randomized controlled trial
Belal Alshaikh1,2, Jumana Samara3,4,5, Shirin Moossavi3,4
1Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, AB, Canada. balshaik@ucalgary.ca.
Insights
Probiotics significantly reduced the time to full enteral feeds in extremely low-birth-weight infants. These beneficial bacteria also improved tolerance to cow
Area of Science:
- Neonatal Medicine
- Microbiome Research
- Gastroenterology
Background:
- The impact of probiotics on the intestinal microbiota and feeding tolerance in extremely low-birth-weight (ELBW) infants is not well understood.
- Establishing optimal feeding practices and gut health is critical for the survival and development of ELBW infants.
Purpose of the Study:
- To investigate the effects of probiotics on intestinal microbiota composition in ELBW infants.
- To assess the impact of probiotics on feeding tolerance and clinical outcomes in ELBW infants.
Main Methods:
- A randomized controlled trial involving ELBW infants assigned to receive probiotics or no intervention.
- Stool sample analysis to evaluate changes in intestinal microbiota.
- Monitoring of feeding progression, incidence of hematochezia, and need for specialized formulas.
Main Results:
- Infants receiving probiotics achieved full enteral feeds significantly sooner (MD -1.8 days).
- Probiotic use was associated with a trend towards lower incidence of hematochezia and reduced need for extensively hydrolyzed or amino acid-based formulas.
- Multi-strain probiotics increased fecal Bifidobacterium and Lactobacillus while reducing Candida abundance.
Conclusions:
- Probiotics can sustain beneficial intestinal bacteria like Bifidobacterium and Lactobacillus in extremely preterm infants.
- Probiotic supplementation may improve feeding tolerance and reduce the time to achieve full enteral feeds in ELBW infants.
- Probiotics show potential in improving tolerance to cow's milk protein supplements in this vulnerable population.
Background:
Effects of probiotics on intestinal microbiota and feeding tolerance remain unclear in extremely low-birth-weight (ELBW) infants.
Methods:
ELBW infants were randomly assigned to receive probiotics or no intervention. Stool samples were collected prior to, 2 and 4 weeks after initiation, and 2 weeks after probiotics cessation for infants in the probiotics group, and at matched postnatal age time points for infants in the control group.
Results:
Of the 102 infants assessed for eligibility, sixty-two were included. Infants who received probiotics reached full enteral feeds sooner (Mean difference (MD) -1.8; 95% CI:-3.7 to -0.01 day), had a tendency toward lower incidence of hematochezia before hospital discharge (22.6% vs 3.2%; P = 0.053), and were less likely to require extensively hydrolyzed- or amino acids-based formulas to alleviate signs of cow's milk protein intolerance in the first 6 months of life (19.4% vs 51.6%; P = 0.008). Infants on probiotics were more likely to receive wide-spectrum antibiotics (64.5% vs 32.2%; P = 0.01). Multi-strain probiotics resulted in significant increase in fecal Bifidobacterium (P < 0.001) and Lactobacillus (P = 0.005), and marked reduction in fecal candida abundance (P = 0.04).
Conclusion:
Probiotics sustained intestinal Bifidobacterium and reduced time to achieve full enteral feeds in extremely preterm infants. Probiotics might improve tolerance for cow's milk protein supplements.
Clinical Trial Registration:
This trial has been registered at www.
Clinicaltrials:
gov (identifier NCT03422562).
Impact:
Probiotics may help extremely preterm infants achieve full enteral feeds sooner. Probiotics may improve tolerance for cow's milk protein supplements. Multi-strain probiotics can sustain intestinal Bifidobacterium and Lactobacillus until hospital discharge.
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