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School-Age Neurodevelopmental and Atopy Outcomes in Extremely Preterm Infants: Follow-Up from the Single Versus
Gayatri Athalye-Jape1,2, Chandra Rath1,2,3, Meera Esvaran4
1Neonatology, King Edward Memorial Hospital, Child and Adolescent Health Service, Perth, WA 6008, Australia.
Insights
Short-term single-strain and triple-strain Bifidobacterium probiotics showed comparable safety and long-term neurodevelopmental, growth, and atopy outcomes in extremely preterm infants. Both probiotic formulations are suitable for this vulnerable population.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Microbiome Research
Background:
- Probiotic supplementation is common for very preterm infants, but long-term neurodevelopmental, growth, and atopy outcomes require assessment.
- The SiMPro trial previously evaluated short-term effects of single-strain (SS) versus triple-strain (TS) Bifidobacterium probiotics in extremely preterm infants.
Purpose of the Study:
- To assess the five-year neurodevelopmental, growth, and blood pressure outcomes of extremely preterm infants following short-term probiotic supplementation.
- To evaluate atopy-related outcomes at school age in infants who received either SS or TS probiotics.
Main Methods:
- A follow-up study of infants from the SiMPro randomized trial assessed neurodevelopment (cognition, behavior, executive function), growth, and blood pressure at five years.
- Atopy-related outcomes were evaluated at six to seven years using the ISAAC questionnaire.
- Longitudinal outcomes were analyzed using linear mixed models, and impairment indicators were modeled using logistic regression.
Main Results:
- Neurodevelopmental outcomes, including severe impairment (FSIQ < 70), growth, BMI, and blood pressure, were comparable between the SS and TS probiotic groups.
- Executive function, disability rates, and atopy-related outcomes also showed no significant differences between the groups.
- Follow-up rates were high in both groups (SS: 89.2% vs. TS: 95%).
Conclusions:
- Both single-strain and triple-strain Bifidobacterium probiotic formulations are safe for extremely preterm infants.
- These probiotic interventions resulted in comparable neurodevelopmental, growth, and atopy-related outcomes at school age.
Abstract:
Background: Probiotic supplementation for very preterm infants is a common practice in many neonatal units. Assessing the effects of early postnatal exposure to probiotics on long-term neurodevelopment, growth, and atopy-related outcomes is important. Extremely preterm (EP: <28 weeks) infants enrolled in our previously reported randomized trial (SiMPro) comparing short-term effects of single (SS: B. breve M-16V) versus triple-strain (TS: B. breve M-16V, B. longum subsp. infantis-M63, B. longum subsp. longum-BB536) probiotic provided a unique opportunity to study this issue. Methods: This follow-up study assessed the five-year outcomes of SiMPro trial infants, including neurodevelopment (cognition (Full Scale Intelligence Quotient/ FSIQ using WPPSI-IV), behavior (Strengths and Difficulties Questionnaire), executive function (BRIEF-P)), growth (anthropometry) and blood pressure (BP). Atopy-related outcomes were evaluated at six to seven years using the ISAAC questionnaire. A linear mixed model was used for longitudinal outcomes. Impairment indicators were modeled using logistic regression and adjusted for Socio-Economic Indexes for Areas (SEIFA) centiles. Results: Follow-up rates (SS: 89.2% versus TS: 95%), neurodevelopmental outcomes [severe impairment (FSIQ < 70): SS: 7.4% versus TS: 4.3%; p = 0.68], growth, BMI, and BP were comparable between the SS and TS groups. The total difficulty score or BRIEF-P executive indices, disability rates (none: 66.7% versus 55.4%), and atopy-related outcomes were comparable between groups. Conclusions: Both TS and SS Bifidobacterium probiotic formulations were safe, with comparable neurodevelopmental, growth, and atopy-related outcomes at school age.
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