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Efficacy of probiotic supplementation in preventing necrotizing enterocolitis in preterm infants: a systematic review
Abdihafid Mohamed Abdullahi1, Shuangkui Zhao1, Yanping Xu1
1Department of NICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Bifidobacterium bifidum G001 (BBG001) probiotic supplementation significantly reduced necrotizing enterocolitis (NEC) and sepsis in preterm infants. Further research is needed to confirm BBG001
Area of Science:
- Neonatal Medicine
- Microbiology
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a critical condition in preterm infants, characterized by intestinal inflammation and bacterial invasion, leading to significant morbidity and mortality.
- The potential of probiotics to mitigate NEC by modulating gut microbiota is recognized, yet the specific efficacy of Bifidobacterium bifidum G001 (BBG001) remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of BBG001 compared to placebo in preventing NEC, late-onset sepsis, and all-cause mortality in preterm infants.
- To synthesize evidence from randomized controlled trials (RCTs) to assess BBG001's impact on neonatal outcomes.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines, including RCTs published between 2014 and 2024.
- Studies involving preterm infants (<37 weeks gestation or <2500g birth weight) receiving enteral BBG001 versus placebo were included. Outcomes included NEC (≥stage II), late-onset sepsis, and all-cause mortality.
Main Results:
- Nine studies with 7180 infants indicated BBG001 significantly reduced NEC stage >2 (OR=0.66), mortality and morbidity (OR=0.74), and sepsis (OR=0.71).
- BBG001 also lowered the incidence of periventricular leukomalacia (OR=0.61) and intraventricular hemorrhage (OR=0.48), and reduced infection-related deaths (OR=0.80).
Conclusions:
- BBG001 supplementation demonstrates efficacy in decreasing NEC incidence, bloodstream infections, and infection-related mortality in preterm infants.
- While results are promising, further large-scale RCTs are recommended to solidify BBG001's role in neonatal care due to study design variability.
Background:
Necrotizing enterocolitis (NEC) is a severe condition in preterm infants, involving intestinal inflammation and bacterial invasion, leading to high morbidity and mortality. Probiotics may reduce NEC by promoting beneficial gut bacteria, but the role of Bifidobacterium bifidum G001 (BBG001) is not well understood. This meta-analysis evaluates the effectiveness of BBG001 versus placebo in preventing NEC, late-onset sepsis, and all-cause mortality in preterm infants.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from 2014 to 2024. Databases searched included PubMed, Cochrane Central Register, MEDLINE, and EMBASE. Inclusion criteria encompassed RCTs involving preterm infants (<37 weeks gestation and/or <2500 g birth weight) receiving enteral probiotics, including BBG001, compared to placebo. Outcomes assessed were incidence of NEC (≥stage II), late-onset sepsis, and all-cause mortality. Data extraction and quality assessment were independently performed.
Results:
From 430 identified records, nine studies involving 7180 preterm infants met the inclusion criteria. BBG001 significantly reduced the risk of NEC stage >2 (OR = 0.66; 95% CI [0.47, 0.94], p = .02), mortality and morbidity (OR = 0.74; 95% CI [0.62, 0.89], p = .001), and sepsis (OR = 0.71; 95% CI [0.53, 0.93], p = .01). It also lowered the odds of periventricular leukomalacia (OR = 0.61; 95% CI [0.47, 0.78], p < .0001) and intraventricular hemorrhage (OR = 0.48; 95% CI [0.33, 0.69], p < .0001). Additionally, BBG001 showed a protective effect against infection-related outcomes, reducing the odds of death attributed to infection (OR = 0.80; 95% CI: 0.65, 0.99; p = .04).
Conclusions:
Probiotic supplementation with BBG001 appears effective in reducing NEC incidence, bloodstream infections, and infection-related deaths in preterm infants. Despite promising results, variability in study designs necessitates further large-scale RCTs to confirm these findings and establish BBG001's role in neonatal care.
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