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Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey
Morcos Hanna1, Irfan Ahmad2, Toby Yanowitz3
1Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Insights
Probiotic use in preterm infants is increasing in U.S. NICUs, but practices vary widely. The American Academy of Pediatrics (AAP) statement had a modest impact, highlighting the need for standardized guidelines and regulation.
Area of Science:
- Neonatal care
- Pediatric gastroenterology
- Microbiome research
Background:
- Probiotic supplementation is recognized for potential health benefits in preterm infants.
- The 2021 American Academy of Pediatrics (AAP) statement recommended caution regarding probiotic use due to practice heterogeneity and lack of federal regulation.
Purpose of the Study:
- To assess the impact of the 2021 AAP statement on probiotic use in neonatal intensive care units (NICUs).
- To evaluate current institutional patterns of probiotic supplementation in U.S. NICUs.
Main Methods:
- A cross-sectional, web-based survey was distributed to 430 institutions within the Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group.
- The survey collected data on probiotic formulations, initiation/cessation criteria, reasons for discontinuation, and the influence of the AAP statement.
Main Results:
- Thirty-nine percent of responding hospitals (95 total) currently use probiotics, with 14 different formulations reported.
- The AAP statement influenced decisions at 24% of hospitals, leading 11% to discontinue use; 37% of non-users are considering initiation.
- Significant variability exists in probiotic formulations, initiation criteria (e.g., birth weight <1,500g, gestational age <32 weeks), and parental consent practices (30% of institutions).
Conclusions:
- Probiotic use in U.S. NICUs is increasing but characterized by significant variability.
- The 2021 AAP statement has had a variable and modest impact on current clinical practices.
- There is a critical need for enhanced federal regulation and consensus guidelines to standardize probiotic use in preterm infants.
Objective:
Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States.
Study Design:
A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact.
Results:
Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation.
Conclusion:
Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use.
Key Points:
· Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..
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