, et al
Probiotics reduce mortality and morbidity in preterm, low birth weight infants: a systematic review and network meta-analysis of randomized trials [published online ahead of print June 24, 2020]
;S0016–5085(20)34849–6. doi:

Investigators from multiple institutions conducted a meta-analysis to assess the effectiveness of various single-strain and multi-strain probiotic formulations in preventing morbidity and mortality in preterm infants. Investigators used several databases (eg, Medline, Embase, Scopus) to identify randomized controlled trials through January 1, 2019 that featured single- or multiple-strain probiotics for prevention of morbidity and mortality in infants <37 weeks gestation and/or infants with a birth weight <2,500 grams. For each eligible study, reviewers extracted details of the intervention (eg, probiotics species and strains) and outcomes, particularly all-cause mortality, severe necrotizing enterocolitis (NEC, defined as stage II or greater based on Bell’s criteria), number of days to reach full feeding, and duration of hospitalization. Investigators aggregated the data across included studies and assessed the effect of the intervention compared to placebo on each outcome.

There were 63 studies involving 15,712 infants included in the analysis. The median of the average birth weight was 1,204 g, and the median of the average gestational age was 30.1 weeks. The majority of studies assessed multiple-strain probiotic products.

Compared to placebo, combinations of Lactobacillus spp and Bifidobacterium spp reduced all-cause mortality (OR 0.56; 95% CI, 0.39, 0.80). Similarly, combinations of Lactobacillus spp and Bifidobacterium spp reduced severe NEC (OR 0.35; 95% CI, 0.20, 0.59); single-strain Bifidobacterium animalis subsp lactis also reduced severe NEC (OR 0.31; 95% CI, 0.13, 0.74). Combinations of Lactobacillus spp, Bifidobacterium spp, and Saccharomyces boulardii reduced the number of days to full feeding (mean reduction 3.30 days; 95% CI, 0.91, 5.91). Single-strain Lactobacillus reuteri or Bifidobacterium animalis subsp lactis reduced duration of hospitalization (mean reduction of 13 days; 95% CI, 3.29, 22.71).

The authors conclude there is high-quality evidence that several single- or multiple-strain probiotics reduce morbidity or mortality in preterm infants.

Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

The human gut is a complex ecosystem in which microbiota, nutrients, and host cells interact extensively, a process crucial for intestinal homeostasis. The various bacterial communities that make up the intestinal microbiota have many functions, including metabolic, barrier, and trophic activities. Hence, any dysbiosis could have negative consequences in terms of health; many diseases have been linked to impairment of the gut microbiota, including inflammatory bowel disease, irritable bowel syndrome, and celiac disease. The close relationships between gut microbiota, health, and disease have led to great interest in using probiotics to positively modulate the gut microbiota to prevent or treat some diseases, such as NEC. Probiotic administration may have great potential in terms of health that justifies more research.

Probiotics are defined as live bacteria that, when administered in adequate numbers, confer health...

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