Intestinal Colonization Rate of Candida albicans among Low Birth Weight Neonates after Using Oral Synbiotic Supplementation: A Randomized Placebo-controlled Trial

Document Type: Original Article

Authors

1 Department of Pediatrics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Background: The present study aimed to evaluate the effect of synbiotics on the intestinal colonization rate of Candida albicans in low birth weight neonates (i.e., under 2,500 g), which is one of the most important events for necrotizing enterocolitis (NEC).
Methods: During one year, 106 preterm neonates with a birth weight of less than 2,500 g, admitted to the Neonatal Intensive Care Unit (NICU) of Imam Reza Hospital, affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, were randomly selected and investigated in two groups of case and control. In the case group, 5 drops of synbiotics (under the trade name of Pedilact in which 5 drops are equivalent to 2.5×108 CFU), containing three probiotics of Bifidobacterium infantis, Lactobacillus rhamnosus, and Lactobacillus reuteri, as well as the prebiotic of fructooligosaccharide, were administered. On the other hand, 5 drops of distilled water were used for the control group. In the present single-blind study, the subjects were divided into two groups using a random number table. The stool cultures were obtained on the 1st and 10th days of admission. Then, the two groups were compared in terms of the amount of positive stool culture for Candida albicans, time of feeding initiation and full nutrition, duration of hospitalization, and time of discharge.
Results: The incidence rate of positive stool culture for Candida albicans was 6.6%. A significant relationship was observed between gestational age and positive culture (P=0.009). However, there was no significant difference between the two groups in terms of the duration of hospitalization, time of feeding initiation and full feeding, good physical examination results, and wellbeing. In addition, the relationship between positive culture and birth weight was statistically significant (P=0.045) since the rates of positive culture were 57.1% and 42.9% in cases with the birth weight of ≤ 1,500 and > 1,500 g, respectively.
Conclusion: Based on the results, synbiotic use showed no significant relationship with enteral positive cultures for Candida albicans, time of enteral feeding initiation and full feeding, and hospitalization duration.

Keywords


1. Polin R, Randis TM. Perinatal infections and chorioamnionitis. Fanaroff and Martin's neonatalperinatal medicine. 11th ed. Philadelphia, PA: Elsevier; 2020. P. 809-14.
2. Remington JS, Klein JO. Remington & Klein infection disease of the fetus & newborn infant. 8th ed.
Philadelphia, PA: Elsevier; 2015. P. 1058-75.
3. MacDonald MG, Seshia MM. Avery's neonatology:pathophysiology and management of the newborn.
7th ed. Philadelphia: Lippincott Williams & Wilkins;2015. P. 983.
4. Roy A, Chandhari J, Sankar D, Ghosh P, Chakraborty S. Role of enteric supplementation of probiotics on late-onset sepsis by Candida species in preterm low birth weight neonates: a randomized, double blind, placebo-controlled trial. N Am J Med Sci. 2014;6(1):50-7.
5. AlFalah K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Evid Based Child Health. 2014; 9(3):584-671
6. Benjamin DK, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal candidiasis: epidemiology,risk factors, and clinical judgment. Pediatrics. 2010;126(4):e865-73.
7. Romeo MG, Romeo DG, Trovato L, Oliveri S,Palermo F, Cota F, et al. Role of probiotics in the presentation of the enteric colonization by candida in preterm newborn: incidence of late-onset sepsis
and neurological outcome. J Perinatol. 2011;31(1):63-9.
8. Steinbach WJ. Epidemiology of invasive fungal infections in neonates and children. Clin Microbiol
Infect. 2010; 16(9):1321-7.
9. Zaoutis T. Candidemia in children. Curr Med Res Opin. 2010; 26(7):1761-8.
10. Agarwal RR, Agarwal RL, Chen X, Lua JL, Ang JY.Epidemiology of invasive fungal infections at two
tertiary care neonatal intensive care units over a 12-year period (2000-2011). Global Pediatr Health.2017; 4:2333794X17696684.
11. Aliaga S, Clark RH, Laughon M, Walsh TJ, Hope WW,Benjamin Dk, et al. Changes in the incidence of candidiasis in neonatal intensive care units.Pediatrics. 2014; 133(2):236-42.
12. Manzoni P, Jacqz-Aigrain E, Rizzollo S, Franco C,Stronati M, Mostert M, et al. Antifungal prophylaxis in neonates. Early Hum Dev. 2011; 87:S59-60.
13. Oncel MY, Erdeve O, Dilmen U. Probiotics for necrotizing enterocolitis: not always a success story.
J Pediatr. 2014; 165(2):417.
14. Pammi M, Abrams SA. Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in
preterm infants. Cochrane Database Syst Rev. 2015;2:CD007137.
15. Vongbhavit K, Underwood MA. Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant. Clin Ther. 2016; 38(4):716-32.

16. Johnson-Henry KC, Abrahamsson TR, Wu RY, Sherman PM. Probiotics, prebiotics, and synbiotics for the prevention of necrotizing enterocolitis. Adv Nutr. 2016; 7(5):928-37.

17. Nandhini LP, Biswal N, Adhisivam B, Mandal J, Bhat BV, Mathai B. Synbiotics for decreasing incidence of
necrotizing enterocolitis among preterm neonates - a randomized controlled trial. J Matern Fetal Neonatal Med. 2016; 29(5):821-5.
18. van den Nieuwboer M, Claassen E, Morelli L, Guarner F, Brummer RJ. Probiotic and synbiotic safety in infants under two years of age. Benef Microbes. 2014; 5(1):45-60.