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Effect of probiotics on necrotizing enterocolitis in preterm infants: a network meta-analysis of randomized

Yu Dai1, Qinlei Yu1, Fan Zhang1

  • 1Department of Pediatrics, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, 123 Tian Fei Xiang, Mo Chou Road, Nanjing, 210004, China.

BMC Pediatrics
|March 27, 2025
PubMed

Insights

Probiotics significantly reduce necrotizing enterocolitis (NEC) and mortality in preterm infants. Specific combinations, like Bifidobacterium, Lactobacillus, and Enterococcus, show the most promise for improved outcomes and shorter hospital stays.

Area of Science:

  • Neonatal Medicine
  • Microbiome Research
  • Clinical Nutrition

Background:

  • Previous research suggests probiotics offer benefits for preterm infants, but efficacy varies by strain.
  • Necrotizing enterocolitis (NEC) remains a significant concern in preterm infant care.
  • The optimal probiotic strategy for preterm infants requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of various probiotics in preventing NEC and related outcomes in preterm infants.
  • To conduct a network meta-analysis comparing different probiotic interventions against placebo.
  • To identify specific probiotic species or combinations with the greatest clinical benefit.

Main Methods:

  • Network meta-analysis of 51 randomized controlled trials.
  • Inclusion of 11,661 preterm infants.
  • Assessment of outcomes including NEC incidence, mortality, hospital stay, and feeding advancement.

Main Results:

  • Most probiotics reduced NEC incidence (Bell's stage II or higher).
  • Specific combinations (Bifidobacterium, Lactobacillus, Streptococcus) significantly reduced all-cause mortality.
  • Lactobacillus alone shortened hospital stays and accelerated full enteral feeding.

Conclusions:

  • The combination of Bifidobacterium, Lactobacillus, and Enterococcus demonstrated the highest efficacy in reducing NEC and mortality.
  • Prebiotics and Lactobacillus monotherapy effectively reduced hospitalization duration and time to full enteral feeding.
  • Probiotics did not show a significant impact on sepsis risk in this analysis.
Abstract

Keywords:
Feeding intoleranceNecrotizing enterocolitisNetwork meta-analysisPreterm infantsProbiotics

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