Probiotics in Preemies: Lifesaving Therapy

Lots of studies have indicated that probiotics may be beneficial in premature newborns; the problem is that there are currently no FDA-approved probiotics for preterm infants. The use of probiotics as a non-regulated FDA product leads to the potential risk of contamination due to inconsistent quality control as well as variability in the strains and concentrations.  The risks are not inconsequential as there has been a report of 29-week infant who died from mucormycosis due to probiotic contamination with mold.

Despite the potential problems with probiotics in this population, their usage is increasing as described in a recent multicenter retrospective cohort study (KD Gray et al. J Pediatr 2020; 222: 59-64) which took place between 1997-2016 with 78,076 infants (23-29 weeks gestational age) in 289 NICUs.

Key findings

  • 3626 (4.6%) received probiotics
  • Probiotic use increased over the study period (>10% in 2015 & 2016)
  • By matching 2178 infants who received probiotics with 33,807 without probiotics, the authors determined that those received probiotics had a decrease likelihood of necrotizing enterocolitis (OR 0.62) and death (OR 0.52).  The authors observed an increase in Candida infection (OR 2.23); though, this is an infrequent infection and the absolute difference in risk was <1%
  • Limitations: “similar to many previous studies, there was great variation in probiotic products and organisms, as well as a lack of dosing information, which made it unclear which product, organism, or dose might be most effective.”  Also, other contributing factors like consumption of breastmilk and antibiotic exposure are not detailed in this report.

My take: Probiotics could be life-saving for premature infants. It would be nice if we could find out which strains work and which ones do not as well as to assure safe manufacturing processes.

Related blog posts:

Continuous Feeds versus Bolus Feeds

Briefly noted:

Another study (JB van Goudoever et al. JPGN 2015; 61: 659-64) indicates that bolus feeds are likely as safe as continuous feeds in preterm infants; though, the “continuous” feeding was atypical.  In this study, the bolus group received their feedings every 3 hours via gravity whereas the “continuous” feeding cohort received feedings by gravity by giving one-fourth of the hourly feeding every 15 minutes.

Key finding: In a study of 246 infants (<1750 g & <32 weeks gestational  age), there was no significant difference in reaching full enteral feedings between the group assigned to continuous feedings compared with bolus feedings

Related blog post:  Which is Safer -Drip Feeds or Bolus Feeds in Healthy Preterm …