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Jury still out on probiotics for premature neonates
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Lactobacillus reuteri may play a role in decreasing hospitalization and feeding intolerance in prematurely-born infants but more data are needed, according to a study published online.
Mario A. Rojas, MD, MPH, of Wake Forest School of Medicine, and colleagues from the Colombian Neonatal Research Network (CNRN) randomly assigned 750 infants weighing less than 2000 g during their first two days of life to a once-a-day probiotic regimen or placebo.
The researchers noted that death and nosocomial infection rates were similar in both groups, but hospital-associated pneumonia rates were slightly lower in the probiotic group. Necrotizing enterocolitis was decreased by 40% but this difference did not reach statistical significance.
“Episodes of feeding intolerance and duration of hospitalization were lower in infants (9.6% vs 16.8% [P =.04]; 32.5 days vs. 37 days [P = .03]),” the researchers wrote.
Rojas and colleagues noted several possible explanations as to why the probiotics did not affect death and nosocomial infection rates, including lack of power to find a difference, inclusion of low risk premature infants (1500-2000 grams) and other possible explanations such as dose of probiotics used may not have been “sufficient to colonize the gut of premature infants or that treatment with antibiotics, which frequently are given to premature infants, did not allow sufficient growth of L. reuteri.”
The researchers concluded that their studies backed earlier findings on probiotics, and “although L. reuteri did not appear to decrease the rate of the composite outcome, the trends suggest a protective role for mortality, nosocomial infection, and necrotizing enterocolitis.”
“Our study is not a negative study but a well designed study that lacked power to find a difference in the combined outcome,” Rojas said. “The observed 40% decrease in the incidence of necrotizing enterocolitis with L. reuteri is clinically relevant as well as the trend for a decrease in hospital associated pneumonia. Exposure to L. reuteri decreased frequency of patients with feeding intolerance episodes and shortened duration of hospitalization. Because of the quality of its design, our study will strengthen future meta-analyses on this subject.”
Disclosure: Dr Rojas reports acting as a consultant for BioGaia without honorarium; the other authors indicated they have no financial conflicts of interest.
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