Editor’s Note: Abby Temple (she/her/hers) is a resident physician in the Boston Combined Residency Program. She is interested in the integration of advocacy and health equity research into undergraduate medical education. Abby is interested in pursuing a fellowship specializing in gastroenterology or critical care. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The use of probiotics, or supplements that contain healthy bacteria to aid in digestion, has become widespread over the last decade, with a 4-fold increase in probiotic users between 2007 and 2015. Their use has been shown to be beneficial in controlling symptoms and in the prevention of gastrointestinal diseases, including necrotizing enterocolitis (NEC).
NEC is the most prevalent gastrointestinal emergency in infants and is associated with increased morbidity and mortality in affected infants.
However, the use of probiotics in infants, and specifically in infants born preterm who are admitted to neonatal intensive care units (NICUs), is limited due to a lack of FDA regulation of products, varying data on their efficacy, and potential for harm in form of bloodstream infections (sepsis) from bacteria contained within probiotics.
In an article and accompanying video abstract being early released in Pediatrics, Belal Alshaikh, MD, and the Canadian Neonatal Network Investigators investigated the effect of probiotics on reducing risk of NEC and overall mortality in infants born before 34 weeks gestation and infants born at very low birth weights (<1000g) (10.1542/peds.2024-069102). They also investigated the risks, including sepsis, associated with probiotics in this population.
This study found that use of probiotics was associated with decreased risk of mortality in infants born at <34 weeks gestation and infants born at very low birth weights. However, probiotics were not associated with decreased risk of NEC in either group.
While rare, there were associated cases of probiotic sepsis in this study, with 1.4/1000 cases infants born <34 weeks and 4/1000 cases in infants born at low birth weights. All the infants that developed probiotic sepsis also had NEC. Two infants had probiotic sepsis listed as a potential cause of death (1 in 9400 cases).
Despite convincing evidence that probiotics reduce mortality in infants born preterm or with low birth weight, in a solicited commentary, Roger Soll, MD, and Erika Edwards, PhD, from the University of Vermont argue that the existing body of evidence is not consistent enough to justify safe use of probiotics in NICUs (10.1542/peds.2024-069450).
Overall, the question of whether probiotics are beneficial and safe in infants born preterm and with low birth weight is still up for debate. However, the study by Dr. Alshaikh and colleagues provides much needed data from a large population to continue this conversation.
