Prophylactic Probiotics for Prevention of Necrotizing Enterocolitis in Preterm Neonates: A Cohort Study

Bhawan Deep Garg, Nandkishor Shrikishanji Kabra, Haribalakrishna Balasubramanian, Bhupendra Suryanarayan Avasthi, Shobha Rajesh Sharma, Javed Ahmed, Swarup Kumar Dash


Aim: To evaluate whether routine probiotic supplementation prevents necrotizing enterocolitis (NEC) in preterm neonates

Materials and Methods: This was a retrospective cohort study, which included 663 neonates with birth weight ≤ 1500 g or gestational age ≤ 32 weeks. Of the 663 neonates, 354 were administered probiotics before the initiation of enteral feeds at a dosage of 0.0625 x 109 cells BID till 35 weeks of postmenstrual age or until discharge from the neonatal intensive care unit. The remaining 309 neonates served as the standard group. 

Routine use of probiotics in neonates was commenced in our unit from October 1, 2013. We compared the incidence of NEC and mortality in the probiotic group (between October 1, 2013, and June 30, 2015) with that of the standard group (between January 1, 2012, and September 30, 2013). The main outcome was the incidence of NEC ≥ Bell stage II. 

Results: Introduction of probiotics was associated with an absolute reduction in NEC (from 9.71% to 4.8%; unadjusted OR = 0.47; 95% CI: 0.25–0.86; P < .015; relative difference = 4.9%; number needed to treat = 21) and a nonsignificant reduction in the combined outcome of mortality or NEC (from 23.9% to 19.8%, P > .05). After adjusting for potential confounders, improvement was marginally significant for NEC (adjusted OR = 0.52, 95% CI: 0.28–0.99, P = .05).

Conclusions: Probiotic supplementation significantly reduced the incidence of NEC ≥ Bell stage II in preterm neonates. There was no definite reduction in late-onset sepsis or mortality. However, the neonates on probiotic supplementation had less feed intolerance, reached full feeds faster, and showed better weight gain than neonates in the standard group. A reduction in the duration of hospital stay was observed in the probiotic supplementation group. 

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