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Published on: January 27, 2019
Perioperative Probiotic Supplementation to Reduce Postoperative Infection and Inflammation in Children and Neonates
Amani N Alansari1, Marwa Messaoud2,3, Suzie Khogeer4
1Department of Pediatric Surgery, Hamad Medical Corporation, Doha 3050, Qatar.
Insights
Probiotics may reduce postoperative infections and inflammation in pediatric gastrointestinal surgery. Further research is needed to confirm these findings in larger trials.
Area of Science:
- Pediatric Surgery
- Microbiology
- Gastroenterology
Background:
- Pediatric and neonatal gastrointestinal surgery patients face high risks of postoperative infections, inflammation, and delayed recovery.
- Probiotic supplementation is explored for its potential to restore gut microbial balance and improve outcomes.
- This study systematically evaluates probiotics' impact on postoperative results in this vulnerable population.
Purpose of the Study:
- To systematically evaluate the effects of probiotic supplementation on postoperative outcomes in pediatric and neonatal gastrointestinal surgery.
- To assess the impact of probiotics on infection rates, inflammation markers, and gut microbiota.
- To synthesize evidence from randomized controlled trials and observational studies.
Main Methods:
- A systematic review and meta-analysis adhering to Cochrane and PRISMA guidelines.
- Searched major databases (PubMed, Scopus, Cochrane, Web of Science) for relevant studies.
- Included randomized controlled trials (RCTs) and observational studies comparing probiotics to placebo or standard care.
Main Results:
- Eight studies (6 RCTs, 2 cohorts) with 437 patients were analyzed.
- Probiotics significantly reduced postoperative infections (RR=0.49, p=0.027) and C-reactive protein levels (RR=0.42, p<0.001).
- Increased *Bifidobacterium* abundance (SMD=0.84, p<0.001) was observed; no significant effects on hospital stay or *Lactobacillus* levels.
Conclusions:
- Probiotics, especially *Bifidobacterium species*, show potential in reducing postoperative infections and inflammation after pediatric gastrointestinal surgery.
- The current evidence is based on a limited number of studies and small sample sizes.
- Larger, well-designed trials are necessary to confirm these promising findings and establish clinical efficacy.
Background:
Gastrointestinal surgery in children and neonates carries high risks of postoperative infections, inflammation, and delayed recovery. Probiotics may help restore gut microbial balance and improve clinical outcomes. This study systematically evaluates the effects of probiotic supplementation on postoperative outcomes in pediatric and neonatal gastrointestinal surgery.
Methods:
A systematic review and meta-analysis was conducted following Cochrane and PRISMA guidelines. PubMed, Scopus, Cochrane, and Web of Science were searched for randomized controlled trials (RCTs) and observational studies comparing probiotics with placebo, standard care, or surgery alone in children and neonates. Meta-analyses were performed using R programming, with pooled effect estimates reported alongside 95% confidence intervals (CI) and corresponding p-values.
Results:
Eight studies (6 RCTs and two cohorts) with 437 patients were included. Probiotics significantly reduced postoperative infections (risk ratio = 0.49, 95% CI: 0.26-0.92, p = 0.027) and C-reactive protein elevation (risk ratio = 0.42, 95% CI: 0.26-0.68, p < 0.001) and increased Bifidobacterium abundance (standardized mean difference = 0.84, 95% CI: 0.51-1.17, p < 0.001). No significant effect was seen on hospital length of stay or Lactobacillus concentrations. Qualitative synthesis indicated improvements in bowel function, immune markers, and growth in selected neonatal populations.
Conclusions:
Probiotics, particularly Bifidobacterium species, may reduce postoperative infections and inflammation in pediatric gastrointestinal surgery; however, the evidence is based on a limited number of studies and small pooled analyses, and larger well-designed trials are needed to confirm these findings.
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