Iranian Journal of Neonatology

Iranian Journal of Neonatology

Effects of Probiotic Lactobacillus Reuteri (DSM 17938) on the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Premature Infants

Document Type : Original Article

Authors
Mahmoud Nouri Shadkam 1
Fatemeh Jalalizadeh 2
Khadijeh Nasiriani 3
1 Associate Professor, Department of Pediatrics, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
2 Medical Student, Medical College of Ali Ibn Abi Talib, Islamic Azad University, Yazd, Iran
3 Assistant Professor of nursing. Nursing department, Nursing & midwifery school, Shaheed Sadoughi University of Medical Sciences and Health Services, Yazd. Iran.
10.22038/ijn.2015.6143
Abstract
Background: Feeding intolerance is a common problem among premature infants. There is limited information on the safety and effects of oral probiotic supplements, especially products containing Lactobacillus reuteri, and the incidence of necrotizing enterocolitis (NEC) in low birth weight preterm infants. This study aimed to evaluate the effects of Lactobacillus reuteri on the gastrointestinal complications and feeding tolerance in premature infants.
Methods: This randomized triple-blind clinical trial was conducted on 60 premature infants divided into two groups of intervention and placebo. Subjects in the intervention group received one drop/kg of supplementary oral probiotic with 0.5 ml of distilled water, and infants in the placebo group only received 0.5 ml of distilled water. Probiotic administration continued to reach full enteral feeding.
Results: In this study, mean time to reach full enteral feeding was 12.83 and 16.75 days in the intervention and placebo groups, respectively, which was indicative of a significant difference (P=0.01). However, mean of neonatal weight at discharge had no significant difference between the two groups. In addition, 6.7% and 36.7% of infants in the intervention and placebo groups were diagnosed with NEC, respectively, which showed a significant difference (P=0.005). Also, prevalence of jaundice and sepsis was not significantly different between the study groups.
Conclusion: According to the results of this study, Lactobacillus reuteri could reduce the time to reach full enteral feeding while diminishing the incidence of NEC in very low birth weight premature infants.
Keywords
Lactobacillus Reuteri
Necrotizing Enterocolitis
Probiotic
Very Low Birth Weight Infants
1.   Jadcherla SR, Kliegman RM. Studies of feeding intolerance in very low birth weight infants: definition and significance. Pediatrics. 2002; 109(3):516-7.
2.   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.
3.   Brunicardi FC, Schwartz SI. Schwartz's Principles of Surgery. 8th ed. New York: McGraw-Hill Medical Pub Division; 2006.
4.   Kliegman RM, Stanton B, St. Geme J, Schor NF, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011.
5.   Nair V, Soraisham AS. Probiotics and prebiotics: role in prevention of nosocomial sepsis in preterm infants. Int J Pediatr. 2013; 2013:874726.
6.   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.
7.   Bernardo WM, Aires FT, Carneiro RM, Sá FP, Rullo VE, Burns DA. Effectiveness of probiotics in the prophylaxis of necrotizing enterocolitis in preterm neonates: a systematic review and meta-analysis. J Pediatr (Rio J). 2013; 89(1):18-24.
8.   Szajewska H. Probiotics and prebiotics in preterm infants: where are we? Where are we going? Early Hum Dev. 2010; 86 Suppl 1:81-6.
9.   Reid G, Jass J, Sebulsky MT, McCormick JK. Potential uses of probiotics in clinical practice. Clin Microbiol Rev. 2003; 16(4):658-72.
10. Lyra A, Krogius-Kurikka L, Nikkilä J, Malinen E, Kajander K, Kurikka K, et al. Effect of a multispecies probiotic supplement on quantity of irritable bowel syndrome-related intestinal microbial phylotypes. BMC Gastroenterol. 2010; 10:110.
11. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002; 109(4):678-84.
12. 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.
13. Rojas MA, Lozano JM, Rojas MX, Rodriguez VA, Rondon MA, Bastidas JA, et al. Prophylactic probiotics to prevent death and nosocomial infection in preterm infants. Pediatrics. 2012; 130(5):e1113-20.
14. 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.
15. 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.
16. Kitajima H, Sumida Y, Tanaka R, Yuki N, Takayama H, Fujimura M. Early administration of Bifidobacterium breve to preterm infants: randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 1997; 76(2):F101-7.
17. Bin-Nun A, Bromiker R, Wilschanski M, Kaplan M, Rudensky B, Caplan M, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr. 2005; 147(2):192-6.
18. 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.
19. Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics. 2005; 115(1):5-9.