Probiotics protect against death, NEC in preemies
Probiotics appear to be beneficial to preterm, low-birthweight infants, reducing the risk of death and necrotizing enterocolitis (NEC), reports a new meta-analysis.
From the databases of Medline, Embase, CINAHL, Cochrane Central, Scopus, BIOSIS Previews, Google Scholar, and Science Citation Index Expanded, researchers retrieved 63 randomized controlled trials (RCTs) corresponding to 15,712 preterm infants. Most of the multiple-strain probiotics contained Lactobacillus spp with Bifidobacterium spp; nearly half of all single-strain probiotics used Lactobacillus spp.
Pooled analysis of high-certainty evidence showed that the combination of Lactobacillus spp and Bifidobacterium spp almost halved the risk of all-cause mortality relative to placebo (odds ratio [OR], 0.56, 95 percent confidence interval [CI], 0.39–0.80; risk difference [RD], –2.2 percent; 95 percent CI, –3.1 to –0.1).
Similarly, analysis of high- and moderate-certainty evidence showed that combinations of Lactobacillus spp and Bifidobacterium spp were strong suppressors of NEC risk (OR, 0.35, 95 percent CI, 0.20–0.59; RD, –4.1 percent, 95 percent CI, –5.1 to –2.6). Comparable effects were reported for Bifidobacterium animalis subsp lactis, L. reuteri, and Lactobacillus rhamnosus.
Shortcomings in the literature disallowed a statistically strong analysis of the effect of probiotics on culture-proven late-onset sepsis and feed intolerance.
“Moderate-to-high certainty evidence demonstrates the superiority of combinations of one or more Lactobacillus spp and one or more Bifidobacterium spp over alternative single- and multiple-strain probiotic treatments,” researchers said. “Multicentre and large RCT should be prioritized to distinguish between the efficacy of single- and multiple-strain probiotics among preterm infants.”