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Probiotic Receipt and Neurodevelopmental Outcomes of Infants <29 Weeks' Gestation: A Cohort Study
Prakesh S Shah1, Nicole Bando2, Seungwoo Lee2
1Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Probiotics did not harm neurodevelopment or growth in preterm infants and may offer superior outcomes. This study examined neurodevelopment and growth in preterm neonates receiving probiotics in intensive care units.
Area of Science:
- Neonatal Intensive Care Unit (NICU) research
- Developmental Pediatrics
- Microbiome and Infant Health
Background:
- Preterm infants born before 29 weeks gestation face significant neurodevelopmental and growth challenges.
- The role of probiotics in mitigating these challenges within the neonatal intensive care unit (NICU) setting requires further investigation.
Purpose of the Study:
- To evaluate the impact of probiotic administration on neurodevelopment and growth in extremely preterm infants.
- To determine if probiotics are associated with neurodevelopmental impairment or affect growth outcomes in this vulnerable population.
Main Methods:
- Retrospective cohort study of 5191 infants born at <29 weeks gestation across 21 Canadian NICUs (2014-2020).
- Comparison of neurodevelopmental outcomes (cognitive, language, motor scores, cerebral palsy, visual, and hearing impairment) and growth between infants who received probiotics versus those who did not.
- Analysis included logistic regression and propensity score-matched methods to assess equivalence and potential superiority.
Main Results:
- No significant difference in neurodevelopmental impairment was found between groups using logistic regression, indicating equivalence.
- Propensity score-matched analyses suggested probiotics may be superior in preventing significant neurodevelopmental impairment (aRD -4.01%).
- Growth outcomes and most secondary outcomes were similar between the probiotic and no-probiotic groups.
Conclusions:
- Probiotics are not associated with harm to neurodevelopment or growth in preterm neonates.
- Findings suggest potential benefits of probiotics for neurodevelopment and growth in infants born before 29 weeks gestation.
- Further research may confirm the superior neurodevelopmental benefits of probiotics in this population.
Objective:
To examine neurodevelopment and growth following probiotic receipt in neonatal intensive care units.
Study Design:
A national, population-representative, multicenter, retrospective cohort study was conducted on children born at <29 weeks' gestation between January 1, 2014, and December 31, 2020, from 21 neonatal units in Canada who survived and then underwent follow-up between ages 18 and 30 months. Children who received vs did not receive probiotics were compared for the primary outcome of significant neurodevelopmental impairment, defined as any of the following: Bayley Scales of Infant and Toddler Development-III cognitive, language, or motor score <70; cerebral palsy with Gross Motor Function Classification System III-V; hearing aid or cochlear implant; or bilateral visual impairment. Equivalence analyses utilizing a 4% margin for outcomes between groups were conducted using logistic regression and propensity score-matched analyses to calculate adjusted risk difference (RD) and CIs.
Results:
A total of 2749 children in the probiotics group (median gestation 26 weeks and birth weight 920 grams) and 2442 in the no probiotics group (median gestation 26 weeks and birth weight 890 grams) were evaluated. Baseline characteristics were similar between groups. For the outcome of significant neurodevelopmental impairment, logistic regression analyses indicated that probiotics were equivalent to no probiotics (adjusted RD -0.23%, 95% CI: 2.61%, 2.15%), whereas propensity score-matched analyses (1474 pairs of children) indicated probiotics were nonequivalent and potentially superior (adjusted RD -4.01%, 95% CI: 6.92%, -1.01%). Results of the majority of secondary outcomes were similar, including growth outcomes.
Conclusions:
Probiotics were not associated with harm in neurodevelopment and growth of surviving preterm neonates and may be potentially superior to no probiotics for neurodevelopment and growth among surviving preterm neonates <29 weeks' gestation.
