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Robertson, Claire, Savva, George M., Clapuci, Raducu, Jones, Jacqueline, Maimouni, Hassan, Brown, Eleanor, Minocha, Ashish, Hall, Lindsay J. 
ORCID: https://orcid.org/0000-0001-8938-5709 and Clarke, Paul ORCID: https://orcid.org/0000-0001-6203-7632
(2020)
Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and Bifidobacterium probiotics.
Archives of Disease in Childhood: Fetal and Neonatal Edition, 105 (4).
pp. 380-386.
ISSN 1359-2998
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Abstract
Objective: To compare rates of necrotising enterocolitis (NEC), late-onset sepsis, and mortality in 5-year epochs before and after implementation of routine daily multistrain probiotics administration in high-risk neonates. Design: Single-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017. Setting: Level 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK. Patients: Preterm neonates at high risk of NEC: Admitted to NICU within 3 days of birth at <32 weeks' gestation or at 32-36 weeks' gestation and of birth weight <1500 g. Intervention: Prior to 1 January 2013 probiotics were not used. Thereafter, dual-species Lactobacillus acidophilus and Bifidobacterium bifidum combination probiotics were routinely administered daily to high-risk neonates; from April 2016 triple-species probiotics (L.acidophilus,B.bifidum, and B.longum subspecies infantis) were used. Main outcome measures: Incidence of NEC (modified Bell's stage 2a or greater), late-onset sepsis, and mortality. Results: Rates of NEC fell from 7.5% (35/469 neonates) in the pre-implementation epoch to 3.1% (16/513 neonates) in the routine probiotics epoch (adjusted sub-hazard ratio=0.44, 95% CI 0.23 to 0.85, p=0.014). The more than halving of NEC rates after probiotics introduction was independent of any measured covariates, including breast milk feeding rates. Cases of late-onset sepsis fell from 106/469 (22.6%) to 59/513 (11.5%) (p<0.0001), and there was no episode of sepsis due to Lactobacillus or Bifidobacterium. All-cause mortality also fell in the routine probiotics epoch, from 67/469 (14.3%) to 47/513 (9.2%), although this was not statistically significant after multivariable adjustment (adjusted sub-hazard ratio=0.74, 95% CI 0.49 to 1.12, p=0.155). Conclusions: Administration of multispecies Lactobacillus and Bifidobacterium probiotics has been associated with a significantly decreased risk of NEC and late-onset sepsis in our neonatal unit, and no safety issues. Our data are consistent with routine use of Lactobacillus and Bifidobacterium combination probiotics having a beneficial effect on NEC prevention in very preterm neonates.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | late-onset sepsis,microbiota,necrotizing enterocolitis,preterm,very low birth weight,pediatrics, perinatology, and child health,obstetrics and gynaecology ,/dk/atira/pure/subjectarea/asjc/2700/2735 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School Faculty of Medicine and Health Sciences > School of Health Sciences |
| UEA Research Groups: | Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 15 Nov 2019 11:30 |
| Last Modified: | 03 Dec 2023 02:47 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/72973 |
| DOI: | 10.1136/archdischild-2019-317346 |
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