Open AccessProbiotics for preterm infants – time to end all controversies
Author(s) -
AthalyeJape Gayatri,
Patole Sanjay
Publication year - 2019
Publication title -
microbial biotechnology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.287
H-Index - 74
ISSN - 1751-7915
DOI - 10.1111/1751-7915.13357
Subject(s) - medicine , necrotizing enterocolitis , randomized controlled trial , pediatrics , incidence (geometry) , sepsis , meta analysis , retinopathy of prematurity , adverse effect , intensive care medicine , gestational age , pregnancy , physics , optics , biology , genetics
Summary Mortality, necrotising enterocolitis ( NEC ), late onset sepsis ( LOS ) and feeding intolerance are significant issues for very preterm (< 32 weeks) and extremely preterm (< 28 weeks) infants. The complications of ≥ Stage II NEC [e.g. Resection of the gangrenous gut, survival with intestinal failure, recurrent infections, prolonged hospital stay, and long‐term neurodevelopmental impairment ( NDI )] impose a significant health burden. LOS also carries significant burden including long‐term NDI due to adverse effects of inflammation on the preterm brain during the critical phase of development. Frequent stopping of feeds due to feeding intolerance is a significant iatrogenic contributor to postnatal growth failure in extremely preterm infants. Over 25 systematic reviews and meta‐analyses of RCT s (~12 000 participants) have reported that probiotics significantly reduce the risk of all‐cause mortality, NEC ≥ Stage II , LOS and feeding intolerance in preterm infants. Systematic reviews and meta‐analysis of non‐ RCT s have also shown that the benefits after adopting probiotics as a standard prophylaxis for preterm infants are similar to those reported in RCT s. No intervention comes close to probiotics when it comes to significant reduction in death, NEC , LOS and feeding intolerance at a cost of less than a dollar a day irrespective of the setting and baseline incidence of NEC . The common controversies that are preventing the rapid uptake of probiotics for preterm infants are addressed in this paper.