Probiotics for Preterm Infants: A Strain‐Specific Systematic Review and Network Meta‐analysis
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Objectives: Several randomized controlled trials (RCTs) on the use of probiotics to reduce morbidity and mortality in preterm infants have provided inconsistent results. Although meta‐analyses that group all of the used strains together are suggesting efficacy, it is not possible to determine the most effective strain that is more relevant to the clinician. We therefore used a network meta‐analysis (NMA) approach to identify strains with greatest efficacy. Methods: A PubMed search identified placebo‐controlled or head‐to‐head RCTs investigating probiotics in preterm infants. From trials that recorded mortality, necrotizing enterocolitis, late‐onset sepsis, or time until full enteral feeding as outcomes, data were extracted and Bayesian hierarchical random‐effects models were run to construct a NMA. Results: Fifty‐one RCTs involving 11,231 preterm infants were included. Most strains or combinations of strains were only studied in one or a few RCTs. Only 3 of 25 studied probiotic treatment combinations showed significant reduction in mortality rates. Seven treatments reduced necrotizing enterocolitis incidence, 2 reduced late‐onset sepsis, and 3 reduced time until full enteral feeding. There was no clear overlap of strains, which were effective on multiple outcome domains. Conclusions: This NMA showed efficacy in reducing mortality and morbidity only in a minority of the studied strains or combinations. This may be due to an inadequate number, or size, of RCTs, or due to a true lack of effect for certain species. Further large and adequately powered RCTs using strains with the greatest apparent efficacy will be needed to more precisely define optimal treatment strategies.
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Lack of data in preterm infants led to a caution about using D-lactate-producing probiotics in this population, although a controlled trial in healthy full-term infants showed that D-lactate-producing L. reuteri DSM-17938 did not result in acidosis and probiotic-containing infant formulas were not associated with acidosis.
“Lack of data in preterm infants led to a caution about using D-lactate-producing probiotics in this population,125 although a controlled trial in healthy full-term infants showed that D-lactate-producing L. reuteri DSM-17938 did not result in acidosis126 and probiotic-containing infant formulas were not associated with acidosis.127”
From Emerging issues in probiotic safety: 2023 perspectives (2023) · cites this paper as [125]
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- Authors
- van den Akker, C. H. P., van Goudoever, J. B., Szajewska, H., Embleton, N. D., Hojsak, I., Reid, D., Shamir, R., & ESPGHAN Working Group for Probiotics, P. &. C. O. N.
- Affiliations
- Department of Paediatrics Emma Children's Hospital—AMC Amsterdam The Netherlands
- Medical University of Warsaw (PL)
- Newcastle University (GB)
- Ben-Gurion University of the Negev (IL)
- University Medical Center Groningen (NL)
- Tel Aviv University (IL)
- Venue
- Journal of Pediatric Gastroenterology and Nutrition
- Publisher
- Wiley
- Published
- 2018-07
- Volume
- 67
- Issue
- 1
- Pages
- 103-122
- ISSN
- 0277-2116 (ISSN-L)
- 1536-4801
- OpenAlex
- W2793807463
- Cited by
- 167
- References
- 122
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 22 · 2023: 19 · 2022: 17 · 2021: 25 · 2020: 31 · 2019: 27 · 2018: 6
- FWCI
- 2.85
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- Journal of Pediatric Gastroenterology and Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Howard Hughes Medical Institute
- 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, probiotic strains, necrotizing enterocolitis, late-onset sepsis, infant mortality, full enteral feeding
- MeSH terms
- Saccharomyces boulardii, Bacillus coagulans, Bacillus clausii, Network Meta-Analysis, Bifidobacterium, Enteral Nutrition, Humans, Infant, Newborn, Infant, Premature, Lactobacillus, Time Factors, Survival Rate, Sepsis, Probiotics, Enterocolitis, Necrotizing, Streptococcus thermophilus
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