Effect of Probiotics on Enteral Milk Tolerance and Prevention of Necrotizing Enterocolitis in Preterm Neonates

Document Type : Original Article

Authors

1 Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran

2 School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran

3 Bentol Hoda Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran

4 Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran

Abstract

Background: There is a dearth of studies in Iran on the efficacy of probiotics in reducing necrotizing enterocolitis (NEC), yielding contradictory results. Therefore, the present study aimed to assess the effect of probiotics on milk tolerance and the prevention of NEC in preterm neonates.
Methods: This randomized triple-blind clinical trial study was conducted on all preterm neonates between 30 and 36 weeks gestation and birth weight >1250 g hospitalized in the neonatal intensive care unit (NICU) at Bentolhoda Hospital in Bojnurd, Iran. Thereafter, 76 eligible neonates were randomly assigned to two groups of oral placebo (n=38) and BB care probiotic (n=38). Subsequently, the following information was extracted based on the hospital checklist: early or late NEC (after 7 days of birth), types of NEC (grade I, II, and III), length of hospitalization, time to reach complete oral nutrition, weight at discharge, and milk tolerance.
Results: In the current study, 52.6% and 47.4% of newborns in control and intervention groups were male, and no significant difference was observed between the two groups (P= 0.646). The incidence of NEC was significantly reduced among the intervention group. The feeding onset in the placebo group was significantly later, as compared to that in the intervention group. A significant difference was detected between the two groups in the length of hospital stay and weight gain during hospitalization.
Conclusion: As evidenced by the obtained results, the administration of probiotics in preterm neonates might prevent NEC. Moreover, it can shorten the onset time of feeding and hospitalization duration.
 

Keywords

References

  1. Battersby C, Longford N, Mandalia S, Costeloe K, Modi N; UK Neonatal Collaborative Necrotising Enterocolitis (UKNC-NEC) study group. Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population survei-llance study. Lancet Gastroenterol Hepatol. 2017; 2(1):43-51.
  2. Li D, Rosito G, Slagle T. Probiotics for the prevention of necrotizing enterocolitis in neonates: an 8-year retrospective cohort study. J Clin Pharm Ther. 2013; 38(6):445-9.
  3. Amin SC, Remon JI, Subbarao GC, Maheshwari A. Association between red cell transfusions and necrotizing enterocolitis. J Matern Fetal Neonatal Med. 2012; 25(Suppl 5):85-9.
  4. Stewart CJ, Cummings SP. Gut bacteria and necrotizing enterocolitis: cause or effect? Trends Microbiol. 2015; 23(6):332-3.
  5. McGuire W, Young L, Morgan J. Preventing necrotising enterocolitis in very preterm infants: current evidence. Paediatr Child Health. 2015; 25(6):265-70.
  6. Saeidi R, Abadi, MZL, Saeidi A, Robatsangi MG. The effectiveness of mother infant interaction on infantile colic. Iranian Journal of Neonatology. 2014; 4(4):34–38
  7. Bisquera JA, Cooper TR, Berseth CL. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics. 2002; 109(3):423-8.
  8. Saeidi R, Partovi S, Kianifar HR, Robatsangi MG, Ghorbani, Z. Evaluation of massage with oil containing medium chain triglyceride on weight gaining in preterm. Koomesh. 2009; 11(1):1–6
  9. Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. J Pediatr Surg. 2010; 45(7):1391-7.

10. Clark RH, Gordon P, Walker WM, Laughon M, Smith PB, Spitzer AR. Characteristics of patients who die of necrotizing enterocolitis. J Perinatol. 2012; 32(3):
199-204.

11. Samanta M, Sarkar M, Ghosh P, Ghosh JK, Sinha MK, Chatterjee S. Prophylactic probiotics for prevention of necrotizing enterocolitis in very low birth weight newborns. J Trop Pediatr. 2009; 55(2):128-31.

12. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011; 364(3):255-64.

13. Yang Y, Guo Y, Kan Q, Zhou XG, Zhou XY, Li Y.
A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Braz J Med Biol Res. 2014; 47(9):804-10.

14. Mack DR, Michail S, Wei S, McDougall L, Hollingsworth MA. Probiotics inhibit enteropathogenic E. coli adherence in vitro by inducing intestinal mucin gene expression. Am J Physiol. 1999; 276(4):G941-50.

15. Dilli D, Aydin B, Fettah ND, Özyazıcı E, Beken S, Zenciroğlu A, et al. The propre-save study: effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants. J Pediatr. 2015; 166(3):545-51.e1.

16. Mattar AF, Drongowski RA, Coran AG, Harmon
CM. Effect of probiotics on enterocyte bacterial translocation in vitro. Pediatr Surg Int. 2001; 17(4):265-8.

17. Duffy LC. Interactions mediating bacterial translocation in the immature intestine. J Nutr. 2000; 130(2S Suppl):432S-6S.

18. Chang HY, Chen JH, Chang JH, Lin HC, Lin CY, Peng CC. Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis. PLoS One. 2017; 12(2):e0171579.

19. Jin YT, Duan Y, Deng XK, Lin J. Prevention of necrotizing enterocolitis in premature infants - an updated review. World J Clin Pediatr. 2019; 8(2):23-32.

20. Hunter C, Dimaguila MA, Gal P, Wimmer JE Jr, Ransom JL, Carlos RQ, et al. Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight < 1000 grams: a sequential analysis. BMC Pediatr. 2012; 12:142.

21. Bonsante F, Iacobelli S, Gouyon JB. Routine probiotic use in very preterm infants: retrospective comparison of two cohorts. Am J Perinatol. 2013; 30(1):41-6.

22. Braga TD, da Silva GA, de Lira PI, de Carvalho
Lima M. Efficacy of Bifidobacterium breve and Lactobacillus casei oral supplementation on necrotizing enterocolitis in very-low-birth-weight preterm infants: a double-blind, randomized, controlled trial. Am J Clin Nutr. 2011; 93(1):81-6.

23. Nouri Shadkam M, Jalalizadeh F, Nasiriani K. Effects of probiotic Lactobacillus reuteri (DSM 17938) on the incidence of necrotizing enterocolitis in very low birth weight premature infants. Iran J Neonatol. 2015; 6(4):15-20.

24. Benor S, Marom R, Ben Tov A, Armoni Domany
K, Zaidenberg-Israeli G, Dollberg S. Probiotic supplementation in mothers of very low birth weight infants. Am J Perinatol. 2014; 31(6):497-504.

25. Lin HC, Hsu CH, Chen HL, Chung MY, Hsu JF, Lien
RI, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial. Pediatrics. 2008; 122(4):693-700.

26. Al-Hosni M, Duenas M, Hawk M, Stewart LA, Borghese RA, Cahoon M, et al. Probiotics-supplemented feeding in extremely low-birth-weight infants. J Perinatol. 2012; 32(4):253-9.

27. Hu XY, Zhou YX, Xu SZ, Lin YY. Effects of probiotics on feeding intolerance in low birth weight premature infants. Zhongguo Dang Dai Er Ke Za Zhi. 2010; 12(9):693-5.

28. Rougé C, Piloquet H, Butel MJ, Berger B, Rochat F, Ferraris L, et al. Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2009; 89(6):1828-35.

29. Indrio F, Riezzo G, Raimondi F, Bisceglia M, Cavallo L, Francavilla R. The effects of probiotics on feeding tolerance, bowel habits, and gastrointestinal motility in preterm newborns. J Pediatr. 2008; 152(6):801-6.

30. Gómez–Rodríguez G, Amador-Licona N, Daza-Benítez L, Barbosa-Sabanero G, Carballo-Magdaleno D, Aguilar-Padilla R, et al. Single strain versus multispecies probiotic on necrotizing enterocolitis and faecal IgA levels in very low birth weight preterm neonates: a randomized clinical trial. Pediatr Neonatol. 2019; 60(5):564-9.

31. Athalye-Jape G, Rao S, Patole S. Effects of probiotics on experimental necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Res. 2018; 83(1-1):16-22.

Iranian Journal of Neonatology
Volume 12, Issue 2
April 2021
Pages 89-94

Files

Share

How to cite

Statistics