Use of Probiotics in the NICU

Part 2

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• Probiotics for prevention of NEC– The primary objective

• To compare the effectiveness and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe (stage II or more) NEC and/or sepsis in preterm infants

– The secondary objective• To conduct a subgroup analysis to investigate the

effect of probiotics in extreme low birth weight infants (infants with birth weight <1000 g)

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• The Available Literature– 191 potentially relevant citations– 179 citations excluded because irrelevant– 12 RCTs were identified as potentially relevant– 10 studies comparing probiotics to control– 9 RCTs included in the meta-analysis– 2 RCTs were excluded since no clinical

outcomes were reported– 1 RCT was deferred till further assessment

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• Prebiotics - Clinical Evidence – 1425 infants were randomized– Highly variable with regard to

• Enrollment criteria• Baseline risk of NEC in the control groups• Timing• Dose• Formulation of the probiotics• Feeding regimens

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• Probiotics – NEC Prevention

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• Probiotics – Mortality

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• Probiotics – Days to Full Feeds

• Probiotics – Safety Profile– Risk of translocation

• Several reported cases with Lactobacillis• No reported cases with Bifidbacterum

– Several reports of probiotic species sepsis have been reported in the literature

• Mostly in immunocompromised hosts• None of the included studies reported sepsis

caused by probiotics organism

– Several cases of sepsis in short gut patients

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• Questions and Probiotics in the NICU– Have we also looked at ↓ antibiotic usage?– Can we initiate practices that facilitate infant

colonization with maternal flora?• C/S without ROM• Early skin-to-skin opportunities

– When using probiotics in the NICU?• Is there evidence of best preparations?• Which preparation is best for neonatal population? • Are the probiotics of human origin?• Where did we get them?• How do we determine dosage?

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• Dosing Prebiotics– Considered supplements– Not regulated by the FDA– Unclear, non-standardized– 3.5 X 107 to 3.5 X 109 CFU– Duh!

• Prebiotics– Non-digestible food ingredients– Fructo-oligosaccharides (FOS)– Galacto-oligosaccharides (GOS)

• Positively affect the endogenous flora

• Stimulate the growth of one or a limited number of bacterial species– FOS - Bifidobacteria– Lactulose - Lactobacilli

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• Synbiotics– A probiotic organism + its prebiotic food– Providing both the organism and substrate at

the time of ingestion may offer improved chance of the prebiotics survival in GI tract

• Risk of adding prebiotics – Recent reports of thickening agents being

linked to NEC– There are similar substances in these agents

and prebiotics

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