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Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical
Rizka Maulida1, Radhian Amandito2, Rinawati Rohsiswatmo3
1Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
Insights
Probiotics significantly reduce late-onset sepsis (LOS) in preterm infants. Multistrain formulations and low-dose regimens showed greater effectiveness in preventing this serious neonatal condition.
Area of Science:
- Neonatal Medicine
- Microbiology
- Preventive Healthcare
Background:
- Late-onset sepsis (LOS) is a major cause of illness and death in preterm infants.
- Probiotics are explored for their potential to improve gut health and immune function, possibly preventing neonatal sepsis.
Purpose of the Study:
- To assess the efficacy of probiotics in preventing LOS in preterm neonates.
- To analyze the impact of different probiotic strains and dosages on LOS incidence.
Main Methods:
- A systematic review and random-effects meta-analysis of 31 studies involving 8,040 preterm neonates.
- Searches conducted across major databases (PubMed, Cochrane CENTRAL, Scopus, ProQuest) up to July 2024.
- Study quality assessed using Cochrane Risk of Bias Tool (RoB 2.0) and evidence certainty evaluated with GRADE.
Main Results:
- Probiotic supplementation significantly reduced the incidence of LOS (pooled RR, 0.83; 95% CI, 0.72 to 0.95).
- Multistrain probiotics (RR, 0.76) and low-dose regimens (RR, 0.72) demonstrated higher efficacy.
- Associated with shorter hospital stays; a trend towards lower mortality was observed but not statistically significant.
Conclusions:
- Probiotics are effective in reducing late-onset sepsis in preterm neonates.
- Specific combinations of multistrain probiotics and optimized dosing strategies may offer the most significant benefits.
- Further research into optimized probiotic interventions is warranted for vulnerable preterm populations.
Abstract:
Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens. Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56 to 0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance. To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.
