Comparison between killed and living probiotic usage versus placebo for the prevention of necrotizing enterocolitis and sepsis in neonates

Abstract

The aim of the study is to compare the role of killed (KP) Lactobacillus acidophilus with living (LP) in reducing incidence of sepsis (NS) and necrotizing enterocolitis (NEC) in neonates. Randomized double blind placebo study, included 150 neonates admitted to NICU at day 1, sixty received oral (LP) and 60 received (KP) and 30 received placebo. One gram of stools was collected on admission, at day 7, at end of the study, as well as on suspected NEC or NS and was sent for culture.

Results: LP and KP were preventive factors for NEC with absolute risk reduction (AAR) 16, 15%, respectively and 18% for NS compared to placebo. Incidence of NEC and NS did not differ significantly between neonates supplemented with LP and those with KP. Preterm neonates supplemented with KP showed significantly lower incidence of NEC compared to placebo, while incidence of NS showed no significant difference between both groups. There is significant reduction in NS and NEC among neonates with positive Lactobacillus colonization of gut compared to those none colonized at day 7 (27.9 vs. 85.9%, 0 vs. 7.8%) and at day 14 (48.7 vs. 91.7% for NS and 0 vs. 20.8% for NEC). Overall comparison between the three groups showed statistical significant reduction in the incidence of NEC. Present conclusions are that early gut colonization with beneficial bacteria lowers the incidence of NEC and NS. KP retained similar benefits to live bacteria.