NeoNotes
Journal Club
Andrew B. Kairalla MD, Editor
6-001 | Additional Comments | Previous
Article | Next Article | Search
| List of Articles | Submit
Comments | Index | FSN Home Page
Oral Probiotics Reduce the Incidence and Severity of Necrotizing Enterocolitis in Very Low Birth Weight Infants. Lin H, Su B, Chen A, et al. Pediatrics (Jan 2005); 115: 1-4.
Objective. We evaluated the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.
Patients and Methods. A prospective, masked, randomized control trial was conducted to evaluate the beneficial effects of probiotics in reducing the incidence and severity of NEC among VLBW (<1500 g) infants. VLBW infants who started to feed enterally and survived beyond the seventh day after birth were eligible for the trial. They were randomized into 2 groups after parental informed consents were obtained. The infants in the study group were fed with Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) with breast milk twice daily until discharged. Infants in the control group were fed with breast milk alone. The clinicians caring for the infants were blinded to the group assignment. The primary outcome was death or NEC ( stage 2).
Results. Three hundred sixty-seven infants were enrolled: 180 in the study group and 187 in the control group. The demographic and clinical variables were similar in both groups. The incidence of death or NEC ( stage 2) was significantly lower in the study group (9 of 180 vs. 24 of 187). The incidence of NEC ( stage 2) was also significantly lower in the study when compared with the control group (2 of 180 vs. 10 of 187). There were 6 cases of severe NEC (Bell stage 3) in the control group and none in the study group. None of the positive blood culture grew Lactobacillus or Bifidobacterium species.
Conclusion. Infloran as probiotics fed enterally with breast milk reduces the incidence and severity of NEC in VLBW infants.
Comments: Probiotics, primarily Lactobacillus species, have been used to treat or prevent a variety of GI disorders with variable success. We now learn that there may be some promise in using this therapy to reduce the risk of NEC in VLBW infants. In the present study, the absolute risk reduction for NEC was 4.2%, which means that 1 case of NEC was prevented for every 24 infants treated. One note of caution … while no cases of invasive infection from the probiotic organisms were seen in the study population, there is a case report in the same issue of Pediatrics that describes 2 cases of Lactobacillus sepsis in older children who were receiving probiotic therapy. The final word on the safety of probiotic therapy in premature infants will have to await further studies. ABK.
Date: 21 Jan 2005
Time: 09:16:18
The use of probiotic therapy in premature infant is a promising .but in this study their outcomes are death, death or NEC and death or NEC or sepsis. Death is a big variable. They didn't specify the cause of death, and if death secondary to NEC or Sepsis they included as one outcome as death in death category or in death or NEC catogory as 2 .
UserName: J Alallah
Institution: neonatal perinatal fellow. HCS .Winnipeg , Canada
telephone: 204 4750886
email:
dr_jubara @hotmail.com
Date: 04 Feb 2005
Time: 08:42:22
Infants on our unit who have clinical NEC are placed on antibiotics and kept NPO
for the course of their antibiotic treatment. Some of these infants are very
hungry before the course of treatment is over! I am curious if anyone
prescribes gut priming (trophic feeds) during the course of treatment if the
baby is clinically stable? I would think trophic feeds with breast milk would
help the gut rather than harm it considering the properties in breast milk, i.e.
epidermal growth factor and immune properties. And how about probiotics in
conjunction with the high antibiotic usage?
UserName: Susan Gibson, MN
Institution: University of Washington Medical Center
telephone: 206-598-4606
email: soozie51@hotmail.com
Date: 25 Feb 2005
Time: 16:56:27
The incidence of NEC varies from institution to institution, but the report of
different networks is around 7 %. This study is significant because of the real
reduction of NEC to 1.1 % in the treatment group versus 5.3% to control. Almost
in all the previous studies using different interventions, the reduction of NEC
was significant comparing to the controls groups but the incidence in the
control were extremely elevated comparing to the average of 7 % and very seldom
in the treatment group was lower this value.
It is encouraging to see this report but we may have to wait until this
observation is confirmed by other studies.
UserName: Amed Soliz
Institution: Miami Children's Hospital
email: aesoliz@aol.com
Date: 06 Mar 2005
Time: 20:40:26
We were curious about whether anyone has any info re: trophic feeds while
children are on ECMO. We have a Thoracic Surgeon who has started feeding at
3cc/hr and we are concerned with outcomes and whether benefits outweigh the
risks. We are also concerned with feedings and having the chest open is any
concern.
UserName: Janet Irwin RN BSN
Institution: OU-Children's Hospital of Oklahoma
telephone: 405-271-4400 between 7p-7a
email: jirwinrn@sbcglobal.net
You may add your own comments to the discussion of this topic by selecting : Submit Comments.