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DOI: 10.1055/s-0038-1647083
Use of Probiotics Is Associated with a Reduction in Severe Necrotizing Enterocolitis in Preterm Infants in New Zealand
Publication History
Publication Date:
27 April 2018 (online)
Introduction: Meta-analysis of randomized controlled trials has indicated reduction in necrotizing enterocolitis (NEC) ≥ stage 2 and mortality following probiotic use in preterm infants. Questions remain regarding which probiotic(s) to use and the risk of probiotic sepsis. Most New Zealand (NZ) tertiary neonatal units started using probiotics as prophylaxis for NEC in 2011. Our aim was to determine if there was a reduction in the incidence of NEC after the introduction of probiotics in NZ. Prior to this, we administered a questionnaire to determine starting dates, strains used, dosages, and side effects. Demographics and outcome data were obtained from a centralized database to which all tertiary neonatal units in Australia and NZ contribute (ANZNN).
Materials and Methods: We compared database demographics and outcomes before (pregroup 2007–2010) and after (postgroup 2013–2015) use of probiotics in NZ for preterm infants < 1,500 g or < 32 weeks’ gestation. (The intervening period from 2011 to 2012 was not included as several units were participants in randomized trials of probiotics.) Five of the six tertiary neonatal units in NZ participated in the study. Clinicians at each hospital reviewed cases of NEC to ensure they fulfilled database inclusion criteria (modified Bell’s stage 2 or more, or diagnosis at surgery or postmortem). Four units used Infloran (Bifidobacterium spp. and Lactobacillus acidophilus) and one unit used Lactobacillus GG (LGG) with bovine lactoferrin (LF). At each hospital, the feeding method of choice was fresh expressed breast milk. Data were obtained from ANZNN as to whether breast milk was used in the early stages of establishing enteral feeds.
Results: A total of 4,248 infants met inclusion criteria and the preprobiotic (2,385) and postprobiotic (1,863) groups were well balanced with regard to gestation (median 29 weeks in both groups), birth weight, gender, and antenatal steroid use. Breast milk use in the early stages of enteral feeding increased significantly from 74 to 87% (p < 0.001).The incidence of NEC in the pregroup was 2.7% and 1.6% in the postgroup (odds ratio: 0.61; 95% confidence interval: 0.38–0.97). There was one case of probiotic sepsis (1 out of 1,863). There was no significant difference between Infloran and LGG/LF in regard to the reduction in NEC rates. Late-onset sepsis rates were significantly lower in the postgroup (p < 0.01) as were retinopathy of prematurity laser treatment rates. Chronic lung disease rates increased in the period studied. Mortality was not significantly different in the two epochs.
Conclusion: While many factors contribute to NEC rates and other neonatal outcomes, introduction of probiotics for preterm infants in NZ has been associated with a significant reduction in severe NEC cases.
Keywords: preterm necrotizing enterocolitis, probiotics late-onset sepsis
No conflict of interest has been declared by the author(s).