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Probiotics reduce risk for late-onset sepsis in preterm infants
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A recent meta-analysis determined that probiotic supplementation reduces the risk for late-onset sepsis in preterm infants, according to results in Pediatrics.
“Late-onset sepsis (LOS) is a major cause of mortality and morbidity, including adverse long-term neurodevelopmental outcomes in preterm infants,” Shripada C. Rao, DM, FRACP, at the School of Pediatrics and Child Health of the University of Western Australia, and colleagues wrote. “Given the serious consequences of LOS in preterm infants, we believe that a strategy that has been shown by this largest neonatal meta-analysis to date is worth consideration by health care policymakers, clinicians, and most importantly, the parents of preterm infants.”
Previously, animal research and in vitro studies have suggested that probiotics inhibit gut colonization with pathogenic bacteria, improve colonization with healthy commensals, protect against enteropathogenic infection through acetate production, enhance innate immunity, and increase maturation of the enteric nervous system, the researchers wrote.
According to a 2014 Cochrane Review of 19 studies with 5,338 patients, however, probiotics did not reduce the risk for LOS in preterm infants. A 2015 meta-analysis of 17 randomized controlled trials also showed similar results. Because these meta-analyses included a maximum of 19 studies, and more than 37 currently are available, Rao and colleagues performed a meta-analyses that collected all available data.
In a 2015 systematic review, three independent reviewers analyzed 37 randomized controlled trials that incorporated 9,416 patients. They compared probiotics with placebo in the treatment of LOS in preterm neonates, born at a gestational age less than 37 weeks or weighing less than 2,500 grams. The researchers defined LOS as the presence of positive blood or cerebrospinal fluid culture collected 48 to 72 hours after birth.
Using a fixed effects model meta-analysis, Rao and colleagues found that probiotics significantly decreased the risk for LOS from 16.3% in the nonprobiotic group to 13.9% in the probiotic group (P = .0007). These results remained significant after the exclusion of studies at high risk for bias.
The researchers attributed sample size for the difference in their results from previous studies.
“It is up to the individual units and clinicians to decide whether an absolute risk reduction of 2.4% is enough to warrant routine supplementation,” Rao and colleagues wrote. “Another important factor that must be considered is the fact that probiotic supplementation has been shown to reduce the risk for necrotizing enterocolitis in preterm infants.
“If a simple intervention such as probiotic supplementation can reduce the risk for two of the most devastating conditions that affect preterm infants, it is worth paying attention.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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