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Probiotics for prevention of necrotizing enterocolitis in preterm infants: systematic review and meta-analysis.

Aceti A, Gori D, Barone G, Callegari ML, Di Mauro A, Fantini MP, Indrio F, Maggio L, Meneghin F, Morelli L, Zuccotti G, Corvaglia L, Italian Society of Neonatolo - Ital J Pediatr (2015)

Bottom Line: Strain-specific sub-meta-analyses showed a significant effect for Bifidobacteria (RR 0.24 [95 % CI 0.10-0.54], p = 0.0006) and for probiotic mixtures (RR 0.39 [95 % CI 0.27-0.56], p < 0.00001).The majority of studies presented severe or moderate microbiological flaws.Probiotics had an overall preventive effect on NEC in preterm infants.However, there are still insufficient data on the specific probiotic strain to be used and on the effect of probiotics in high-risk populations such as extremely-low-birth-weight infants, before a widespread use of these products can be recommended.

View Article: PubMed Central - PubMed

Affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy. arianna.aceti2@unibo.it.

ABSTRACT
Necrotizing enterocolitis (NEC) affects predominantly preterm infants, who have specific risk factors leading to intestinal dysbiosis. Manipulations of gut microbiota through probiotics have the potential to prevent NEC.The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for NEC prevention in preterm infants, with a focus on specific strains, microbiological strength of currently available studies, and high-risk populations.PubMed and the Cochrane Library were searched for trials published within 4th February 2015. Randomized-controlled trials reporting on NEC and involving preterm infants who were given probiotics in the first month of life were included in the systematic review.Twenty-six studies were suitable for inclusion in the meta-analysis.Data about study design, population, intervention and outcome were extracted and summarized independently by two observers. Study quality and quality of evidence were also evaluated.Fixed-effects models were used and random-effects models where significant heterogeneity was present. Subgroup analyses were performed to explore sources of heterogeneity among studies. Results were expresses as risk ratio (RR) with 95 % confidence interval (CI).The main outcome was incidence of NEC stage ≥2 according to Bell's criteria.Probiotics prevented NEC in preterm infants (RR 0.47 [95 % CI 0.36-0.60], p < 0.00001). Strain-specific sub-meta-analyses showed a significant effect for Bifidobacteria (RR 0.24 [95 % CI 0.10-0.54], p = 0.0006) and for probiotic mixtures (RR 0.39 [95 % CI 0.27-0.56], p < 0.00001). Probiotics prevented NEC in very-low-birth-weight infants (RR 0.48 [95 % CI 0.37-0.62], p < 0.00001); there were insufficient data for extremely-low-birth-weight infants. The majority of studies presented severe or moderate microbiological flaws.Probiotics had an overall preventive effect on NEC in preterm infants. However, there are still insufficient data on the specific probiotic strain to be used and on the effect of probiotics in high-risk populations such as extremely-low-birth-weight infants, before a widespread use of these products can be recommended.

No MeSH data available.


Related in: MedlinePlus

Forest plot (2a) and funnel plot (2b) of the included studies. The forest plot shows the association between the use of probiotics and necrotizing enterocolitis in the overall population of preterm infants. The funnel plot does not show any clear visual asymmetry. M-H: Mantel-Haenszel method
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Fig2: Forest plot (2a) and funnel plot (2b) of the included studies. The forest plot shows the association between the use of probiotics and necrotizing enterocolitis in the overall population of preterm infants. The funnel plot does not show any clear visual asymmetry. M-H: Mantel-Haenszel method

Mentions: Data from 6605 infants (3324 in the probiotic group and 3281 in the control group) were analyzed. Fewer infants in the probiotic group developed NEC stage ≥2 compared to infants in the control group (88 [2.65 %] vs. 188 [5.73 %], respectively). The RR was significantly lower in infants treated with probiotics (0.47 [95 % CI 0.36–0.60], p < 0.00001; fixed-effect analysis). NNT was 33 (95 % CI 24.7–47.2), which means that 33 infants needed to be treated with probiotics in order to prevent one more case of NEC stage ≥2. Heterogeneity among trials was absent (I2 = 0 %, p = 0.63; Fig. 2a). The funnel plot did not show any clear asymmetry (Fig. 2b).Fig. 2


Probiotics for prevention of necrotizing enterocolitis in preterm infants: systematic review and meta-analysis.

Aceti A, Gori D, Barone G, Callegari ML, Di Mauro A, Fantini MP, Indrio F, Maggio L, Meneghin F, Morelli L, Zuccotti G, Corvaglia L, Italian Society of Neonatolo - Ital J Pediatr (2015)

Forest plot (2a) and funnel plot (2b) of the included studies. The forest plot shows the association between the use of probiotics and necrotizing enterocolitis in the overall population of preterm infants. The funnel plot does not show any clear visual asymmetry. M-H: Mantel-Haenszel method
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4644279&req=5

Fig2: Forest plot (2a) and funnel plot (2b) of the included studies. The forest plot shows the association between the use of probiotics and necrotizing enterocolitis in the overall population of preterm infants. The funnel plot does not show any clear visual asymmetry. M-H: Mantel-Haenszel method
Mentions: Data from 6605 infants (3324 in the probiotic group and 3281 in the control group) were analyzed. Fewer infants in the probiotic group developed NEC stage ≥2 compared to infants in the control group (88 [2.65 %] vs. 188 [5.73 %], respectively). The RR was significantly lower in infants treated with probiotics (0.47 [95 % CI 0.36–0.60], p < 0.00001; fixed-effect analysis). NNT was 33 (95 % CI 24.7–47.2), which means that 33 infants needed to be treated with probiotics in order to prevent one more case of NEC stage ≥2. Heterogeneity among trials was absent (I2 = 0 %, p = 0.63; Fig. 2a). The funnel plot did not show any clear asymmetry (Fig. 2b).Fig. 2

Bottom Line: Strain-specific sub-meta-analyses showed a significant effect for Bifidobacteria (RR 0.24 [95 % CI 0.10-0.54], p = 0.0006) and for probiotic mixtures (RR 0.39 [95 % CI 0.27-0.56], p < 0.00001).The majority of studies presented severe or moderate microbiological flaws.Probiotics had an overall preventive effect on NEC in preterm infants.However, there are still insufficient data on the specific probiotic strain to be used and on the effect of probiotics in high-risk populations such as extremely-low-birth-weight infants, before a widespread use of these products can be recommended.

View Article: PubMed Central - PubMed

Affiliation: Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy. arianna.aceti2@unibo.it.

ABSTRACT
Necrotizing enterocolitis (NEC) affects predominantly preterm infants, who have specific risk factors leading to intestinal dysbiosis. Manipulations of gut microbiota through probiotics have the potential to prevent NEC.The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for NEC prevention in preterm infants, with a focus on specific strains, microbiological strength of currently available studies, and high-risk populations.PubMed and the Cochrane Library were searched for trials published within 4th February 2015. Randomized-controlled trials reporting on NEC and involving preterm infants who were given probiotics in the first month of life were included in the systematic review.Twenty-six studies were suitable for inclusion in the meta-analysis.Data about study design, population, intervention and outcome were extracted and summarized independently by two observers. Study quality and quality of evidence were also evaluated.Fixed-effects models were used and random-effects models where significant heterogeneity was present. Subgroup analyses were performed to explore sources of heterogeneity among studies. Results were expresses as risk ratio (RR) with 95 % confidence interval (CI).The main outcome was incidence of NEC stage ≥2 according to Bell's criteria.Probiotics prevented NEC in preterm infants (RR 0.47 [95 % CI 0.36-0.60], p < 0.00001). Strain-specific sub-meta-analyses showed a significant effect for Bifidobacteria (RR 0.24 [95 % CI 0.10-0.54], p = 0.0006) and for probiotic mixtures (RR 0.39 [95 % CI 0.27-0.56], p < 0.00001). Probiotics prevented NEC in very-low-birth-weight infants (RR 0.48 [95 % CI 0.37-0.62], p < 0.00001); there were insufficient data for extremely-low-birth-weight infants. The majority of studies presented severe or moderate microbiological flaws.Probiotics had an overall preventive effect on NEC in preterm infants. However, there are still insufficient data on the specific probiotic strain to be used and on the effect of probiotics in high-risk populations such as extremely-low-birth-weight infants, before a widespread use of these products can be recommended.

No MeSH data available.


Related in: MedlinePlus