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Cited by 78Infant Nutrition and HealthProbiotics and Fermented FoodsNeonatal and Maternal Infections

Prophylactic probiotic supplementation for preterm neonates—A systematic review and meta-analysis of nonrandomized studies

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Deshmukh, Mangesh, Patole, Sanjay·2021·Advances in Nutrition
DOI 10.1093/advances/nmaa164PMC PMC8321836
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Abstract

Systematic review and meta-analyses of randomized controlled trials (RCTs) show that probiotics reduce the risk of necrotizing enterocolitis (NEC ≥ Stage II), late onset sepsis (LOS), all-cause mortality, and feeding intolerance in preterm neonates. Data from observational studies is important to confirm probiotic effects in clinical practice. We aimed to compare outcomes before and after implementing routine probiotic supplementation (RPS) in preterm neonates (<37 weeks of gestation) by performing a systematic review of non-RCTs using Cochrane methodology. Databases including PubMed, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Central library, and Google Scholar were searched in May 2020. A meta-analysis was performed using a random effects model. Categorical measure of effect size was expressed as OR and 95% CI. Statistical heterogeneity was assessed by the chi-squared test, I2 statistic. The level of evidence (LOE) was summarized using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. Primary outcomes were NEC ≥ Stage II, LOS, and all-cause mortality. Secondary outcomes included probiotic sepsis. Thirty good-quality non-RCTs (n = 77,018) from 18 countries were included. The meta-analysis showed RPS was associated with significantly reduced: 1) NEC ≥ Stage II (30 studies, n = 77,018; OR: 0.60; 95% CI: 0.50, 0.73; P <0.00001, I2: 65%; LOE: Moderate), 2) LOS: (21 studies, n = 65,858; OR: 0.85; 95% CI: 0.74, 0.97; P = 0.02, I2: 74%; LOE: Low), and 3) all-cause mortality (27 non-RCTs, n = 70,977; OR: 0.77; 95% CI: 0.68, 0.88; P = 0.0001, I2: 49%; LOE: Low). Subgroups: 1) extremely low birth weight (ELBW: birth weight <1000 g) neonates: RPS was associated with significantly reduced NEC ≥ Stage II (4.5% compared with 7.9%). However, there was no difference in LOS and mortality. 2) Multistrain RPS was more effective than single strain. One study reported 3 nonfatal cases of probiotic sepsis. In summary, moderate- to low-quality evidence indicates that RPS was associated with significantly reduced NEC ≥ Stage II, LOS, and all-cause mortality in neonates <37 weeks of gestation and NEC ≥ Stage II in ELBW neonates.

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  • Evidence has been reported showing that probiotic strains can help prevent necrotizing enterocolitis in preterm infants, although the quality of the studies is generally poor.

    “Although the quality of the studies is generally poor [124,125], evidence has been reported showing that probiotic strains can help prevent necrotizing enterocolitis in preterm infants.”

    From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [124]

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Authors
Deshmukh, M., & Patole, S.
Affiliations
  • St John of God Subiaco Hospital (AU)
  • The University of Western Australia (AU)
Corresponding author
  • Deshmukh, Mangesh
  • Patole, Sanjay
ORCID
Venue
Advances in Nutrition
Publisher
Elsevier BV
Published
2021-07
Volume
12
Issue
4
Pages
1411-1423
ISSN
  • 2156-5376 (ISSN-L)
  • 2161-8313
DOI
10.1093/advances/nmaa164
PMC
PMC8321836
OpenAlex
W3121383331
Cited by
78
References
62
Citations by year
2026: 4 · 2025: 12 · 2024: 26 · 2023: 18 · 2022: 12 · 2021: 6
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Advances in Nutrition (publishedVersion, public-domain)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, public-domain)
Funders
Emory University
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
probiotics, preterm infants, necrotizing enterocolitis, late-onset sepsis, all-cause mortality, feeding intolerance, extremely low birth weight infants, observational studies, non-randomized studies, neonatal outcomes, probiotic strains
MeSH terms
Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Sepsis, Probiotics, Enterocolitis, Necrotizing

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