1. Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics
- Author
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Claire Robertson, Jacqueline Jones, Hassan Maimouni, Ashish Minocha, George M. Savva, Raducu Clapuci, Eleanor Brown, Lindsay J. Hall, and Paul Clarke
- Subjects
Male ,medicine.medical_specialty ,Neonatal intensive care unit ,Birth weight ,ved/biology.organism_classification_rank.species ,very low birth weight ,Infant, Premature, Diseases ,Sepsis ,03 medical and health sciences ,Enteral Nutrition ,0302 clinical medicine ,Enterocolitis, Necrotizing ,Intensive Care Units, Neonatal ,030225 pediatrics ,Internal medicine ,microbiota ,medicine ,Humans ,030212 general & internal medicine ,Original Research ,Retrospective Studies ,Bifidobacterium ,necrotizing enterocolitis ,Bifidobacterium bifidum ,biology ,ved/biology ,business.industry ,Incidence ,Probiotics ,Incidence (epidemiology) ,Infant, Newborn ,Obstetrics and Gynecology ,General Medicine ,Late-onset sepsis ,biology.organism_classification ,medicine.disease ,United Kingdom ,3. Good health ,Lactobacillus acidophilus ,Pediatrics, Perinatology and Child Health ,Necrotizing enterocolitis ,Gestation ,Female ,preterm ,business ,Infant, Premature - Abstract
ObjectiveTo compare rates of necrotising enterocolitis (NEC), late-onset sepsis, and mortality in 5-year epochs before and after implementation of routine daily multistrain probiotics administration in high-risk neonates.DesignSingle-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017.SettingLevel 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK.PatientsPreterm neonates at high risk of NEC: admitted to NICU within 3 days of birth at InterventionPrior to 1 January 2013 probiotics were not used. Thereafter, dual-species Lactobacillus acidophilus and Bifidobacterium bifidum combination probiotics were routinely administered daily to high-risk neonates; from April 2016 triple-species probiotics (L. acidophilus, B. bifidum, and B. longum subspecies infantis) were used.Main outcome measuresIncidence of NEC (modified Bell’s stage 2a or greater), late-onset sepsis, and mortality.ResultsRates of NEC fell from 7.5% (35/469 neonates) in the pre-implementation epoch to 3.1% (16/513 neonates) in the routine probiotics epoch (adjusted sub-hazard ratio=0.44, 95% CI 0.23 to 0.85, p=0.014). The more than halving of NEC rates after probiotics introduction was independent of any measured covariates, including breast milk feeding rates. Cases of late-onset sepsis fell from 106/469 (22.6%) to 59/513 (11.5%) (pLactobacillus or Bifidobacterium. All-cause mortality also fell in the routine probiotics epoch, from 67/469 (14.3%) to 47/513 (9.2%), although this was not statistically significant after multivariable adjustment (adjusted sub-hazard ratio=0.74, 95% CI 0.49 to 1.12, p=0.155).ConclusionsAdministration of multispecies Lactobacillus and Bifidobacterium probiotics has been associated with a significantly decreased risk of NEC and late-onset sepsis in our neonatal unit, and no safety issues. Our data are consistent with routine use of Lactobacillus and Bifidobacterium combination probiotics having a beneficial effect on NEC prevention in very preterm neonates.
- Published
- 2019
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