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Published on: January 27, 2019
Reducing Risk Factors for Necrotizing Enterocolitis: What Is the Recent Evidence and Biologic Plausibility Supporting
Linda Dickison1, Carmela Gonzalez-Shalaby
1Alta Bates Summit Medical Center, Ashby Avenue, Berkeley, California.
Insights
Probiotic supplementation significantly reduces necrotizing enterocolitis rates in preterm infants. This review found no adverse effects, supporting probiotics as a safe intervention for neonatal intensive care units (NICUs).
Area of Science:
- Neonatal Medicine
- Microbiome Research
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a multifactorial disease affecting preterm infants in the neonatal intensive care unit (NICU).
- Probiotic supplementation is explored as a strategy to mitigate NEC risk factors.
- Evidence for biologic plausibility, safety, and effectiveness is crucial for clinical adoption.
Discussion:
- Systematic reviews of randomized controlled trials (RCTs) were analyzed to assess probiotic efficacy for NEC prevention.
- Studies focused on specific probiotic strains and excluded adjuncts like prebiotics or antenatal administration.
- Data extraction and critical appraisal using AMSTAR 2 ensured the quality of included systematic reviews.
Key Insights:
- All reviewed systematic reviews demonstrated statistically significant reductions in NEC incidence with probiotic supplementation.
- No adverse effects associated with probiotic use were reported in the included studies.
- Specific probiotic strains show promise in reducing NEC risk.
Outlook:
- Further high-quality RCTs are needed to identify optimal probiotic strains or combinations for NEC prevention.
- Research should focus on determining appropriate dosing and duration of probiotic treatment in preterm infants.
- Advancing probiotic use in the NICU requires robust evidence on strain-specific efficacy and safety profiles.
Background:
Development of necrotizing enterocolitis is multifactorial, with contributing factors that are unique to the preterm infant in the neonatal intensive care unit (NICU). The use of probiotics may reduce these risk factors.
Purpose:
To evaluate evidence of biologic plausibility for probiotic supplementation to mitigate key risk factors implicated in the development of disease and show recent evidence of safety and effectiveness.
Data Sources:
A literature survey of electronic databases, including PubMed, Cochrane Database of Systematic Reviews, and CINAHL, was conducted.
Study Selection:
Selection terms included "necrotizing enterocolitis," "probiotics," and "prematurity." Reviews that were included were full text, in English, and published in the last 5 years. Ten systematic reviews of randomized controlled trials were extracted from 749 records. Excluded were studies that used adjuncts to probiotics, such as lactoferrin or prebiotics, and studies of probiotics given antenatally.
Data Extraction:
Two independent reviewers extracted data to AMSTAR 2, a critical appraisal tool for systematic reviews of randomized or nonrandomized studies of healthcare interventions.
Results:
All the reviews found statistically significant reductions in necrotizing enterocolitis rates after supplementation with probiotics. None of the reviews reported adverse effects.
Implication For Practice And Research:
Probiotic supplementation with specific strains reduces risk for necrotizing enterocolitis. To advance probiotic use in the NICU, additional high-quality trials are needed to focus on specific strains or combinations of strains and to evaluate dosing and duration of treatment.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .
