Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics

Claire Robertson, George M. Savva, Raducu Clapuci, Jacqueline Jones, Hassan Maimouni, Eleanor Brown, Ashish Minocha, Lindsay J. Hall, Paul Clarke

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Abstract

Objective: To 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. Design: Single-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017. Setting: Level 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK. Patients: Preterm neonates at high risk of NEC: Admitted to NICU within 3 days of birth at <32 weeks' gestation or at 32-36 weeks' gestation and of birth weight <1500 g. Intervention: Prior 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 measures: Incidence of NEC (modified Bell's stage 2a or greater), late-onset sepsis, and mortality. Results: Rates 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%) (p<0.0001), and there was no episode of sepsis due to Lactobacillus 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). Conclusions: Administration 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.

Original languageEnglish
Pages (from-to)380-386
Number of pages7
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume105
Issue number4
Early online date30 Oct 2019
DOIs
Publication statusPublished - Jul 2020

Keywords

  • Late-onset sepsis
  • microbiota
  • necrotizing enterocolitis
  • preterm
  • very low birth weight

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