Original Article
Oral Probiotics Prevent Necrotizing Enterocolitis in Very Low Birth Weight Neonates

https://doi.org/10.1016/j.jpeds.2005.03.054Get rights and content

Objective

To test the hypothesis that normalizing the intestinal flora by administration of prophylactic probiotics would provide a natural defense, thereby reducing both the incidence and severity of necrotizing enterocolitis (NEC) in preterm neonates.

Study design

Neonates ≤1500 g birth weight were randomized to either receive a daily feeding supplementation with a probiotic mixture (Bifidobacteria infantis, Streptococcus thermophilus, and Bifidobacteria bifidus; Solgar, Israel) of 109 colony forming units (CFU)/day or to not receive feed supplements. NEC was graded according to Bell's criteria.

Results

For 72 study and 73 control infants, respectively, birth weight (1152 ± 262 g vs 1111 ± 278 g), gestational age (30 ± 3 weeks vs 29 ± 4 weeks), and time to reach full feeds (14.6 ± 8.7 days vs 17.5 ± 13.6 days) were not different. The incidence of NEC was reduced in the study group (4% vs 16.4%; P = .03). NEC was less severe in the probiotic-supplemented infants (Bell's criteria 2.3 ± 0.5 vs 1.3 ± 0.5; P = .005). Three of 15 babies who developed NEC died, and all NEC-related deaths occurred in control infants.

Conclusion

Probiotic supplementation reduced both the incidence and severity of NEC in our premature neonatal population.

Section snippets

Patient Population

Preterm neonates, <1500 g birth weight, who were admitted to the neonatal intensive care unit of the Shaare Zedek Medical Center between September 2001 and September 2004, and who began feeding on a weekday, were recruited for study on the day that they were to begin feeds. The study was approved by our institutional review board, and parental consent was obtained. The infants were prospectively and randomly assigned to one of two groups. The study group received their regular feeds plus a

Results

Of the 145 babies analyzed, 72 were randomized to the study group and 73 to the control group (Table I). No significant differences between the groups were detected. There were no differences in the incidence of culture-proven sepsis of any kind and no differences in the amount of time spent receiving antibiotic therapy.

Discussion

Probiotics may protect against NEC by shifting the intestinal ecological balance from a potentially harmful microflora to one that would be predominantly beneficial to the host.10 The two principal kinds of probiotic bacteria are members of the genera Lactobacillus and Bifidobacterium, which predominate in the normal gut flora of healthy, breastfed, term neonates. Furthermore, probiotics offer protection by strengthening the intestinal mucosal barrier function, which, in turn, impedes the

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    Drs Bromiker and Wilschanski contributed equally to the research culminating in this article.

    Supported by Mr. and Mrs. Stephen Hammerman and the Mirsky Research Fund #18003697.

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