Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants

Context Necrotizing enterocolitis (NEC) is a worldwide problem in very low birth weight (VLBW) infants, with highly variable incidence affecting 2.6% to 28% of these infants. Objectives To evaluate the efficacy of probiotics in reducing the incidence and severity of NEC in VLBW infants. Design Prospective, masked, randomized control trial. Setting A level III neonatal center in the central part of Taiwan. Participants 367 VLBW (< 1500g) infants who started to feed enterally and survived beyond the 7th day after birth. Interventions Infants in the study group were fed with Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) 125 mg/kg with breast milk twice daily until discharge. Infants in the control group were fed with breast milk alone. Main outcome measures Death or NEC ( >= stage 2). Results The incidence of death or NEC ( >= stage 2) was significantly lower in the study group (5% vs 12.8%, P =.009, number needed to treat [NNT] = 13). The incidence of NEC ( >= stage 2) also was significantly lower in the study when compared with the control group (1.1% vs 5.3%, P =.04, NNT = 24). There were six cases of severe NEC (Bell stage 3) in the control group and none in the study group. None of the positive blood Cultures grew Lactobacillus or Bifidobacterium species. Conclusions Infloran as probiotics fed enterally with breast milk reduces the incidence and severity of NEC in VLBW infants. Comment There is a strong rationale to prevent NEC with probiotic agents. Premature infants may be colonized with pathogenic bacteria and develop an aberrant fecal flora that contributes to the pathogenesis of NEC.(1) Probiotics may improve intestinal immune regulation, enhance mucin production, produce antibacterial agents, stimulate IgA production, block mucosal binding, reduce mucosal permeability, and produce anti-inflammatory cytokines.