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Recent advances in the management of infants born <1000 g
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  • Published on: 3 August 2017
    Dual-strain probiotics reduce NEC, mortality and neonatal bloodstream infections among extremely low birth weight (ELBW) infants
    • Luisa Anna Denkel, Infection epidemiologist Institute of Hygiene and Environmental Medicine, Charité University Medical Center
    • Other Contributors:
      • Frank Schwab, Mathematician
      • Lars Garten, Neonatologist
      • Christine Geffers, Infection control specialist
      • Petra Gastmeier, Head of department (Institute of Hygiene and Environmental Medicine)
      • Piening Brar, Infection control specialist

    Berrington and Ward Platt recently summarized current advances in the management of preterm infants born < 1000 g, so called extremely low birth weight (ELBW) infants (1). In this thoroughly done review, the authors highlighted the findings of the 2014 Cochrane review showing probiotics to reduce all-cause mortality and NEC in preterm infants, but not in the subgroup of ELBW infants (2). They hypothesized the lacking protective effect in this extremely vulnerable population to be attributable to their general immaturity, the timing of probiotic exposure or the small sample size of only 575 ELBW infants analyzed. Another recent meta-analysis did not show a significant beneficial effect of probiotics on sepsis in 771 ELBW infants included (3). This demands further studies with adequate power on the use of probiotics in infants born < 1000 g. Almost at the same time, we published a multi-center time series analysis supporting the beneficial effects of dual-strain probiotics on NEC, overall-mortality and nosocomial bloodstream infections (BSI) in preterm infants (4). Beyond that, we performed a subgroup analyses with 4683 ELBW infants. Routine use of dual-strain probiotics significantly reduced the risk of NEC (HR 0.48, 95 % CI 0.36 – 0.64), overall mortality (HR 0.59, 95 % CI 0.41 – 0.84) and nosocomial BSI (HR 0.83, 95 % CI 0.74 – 0.94) in this cohort. Further, probiotics also protected ELBW infants from mortality following NEC (HR 0.40, 95 % CI 0.19 – 0.85). Up to dat...

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    Conflict of Interest:
    None declared.