Effectiveness and Risks of Probiotics in Preterm Infants

Area of Science:

• Neonatal Medicine
• Pediatric Gastroenterology
• Microbiome Research

Background:

• Premature infants (<34 weeks gestation) and those with low birth weight (<1000g) are at high risk for mortality and serious complications.
• Probiotics are explored as a potential intervention to improve outcomes in this population.

Purpose of the Study:

• To assess the efficacy and safety of probiotic administration in extremely preterm infants and those with very low birth weight.
• To determine the impact of probiotics on mortality, necrotizing enterocolitis (NEC), and late-onset sepsis (LOS).

Main Methods:

• Retrospective cohort study of infants born before 34 weeks gestation across 33 Canadian Neonatal Network units (2016-2022).
• Analysis included logistic regression, propensity score matching, and inverse probability of treatment weighting.
• Exclusion criteria targeted infants with poor prognosis or specific conditions precluding analysis.

Main Results:

• Probiotics were administered to 57.5% of eligible infants (<34 weeks gestation).
• Probiotics were associated with reduced mortality (aOR 0.62) but not significantly with lower rates of NEC (aOR 0.92) or LOS (aOR 0.90).
• In infants <1000g, probiotics also decreased mortality (aOR 0.58) without significant reduction in NEC or LOS. Probiotic sepsis was rare (1.4-4/1000) and rarely fatal.

Conclusions:

• Probiotic use in Canadian neonatal intensive care units is linked to decreased mortality in extremely preterm and very low birth weight infants.
• Limited evidence suggests probiotics do not significantly alter rates of NEC or LOS in these infants.
• The risk of probiotic-induced sepsis is low, with few fatalities attributed to this complication.