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Meta-Analysis
. 2017 Feb 9;12(2):e0171579.
doi: 10.1371/journal.pone.0171579. eCollection 2017.

Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis

Hung-Yang Chang  1   2   3 , Jin-Hua Chen  4 , Jui-Hsing Chang  1 , Hung-Chih Lin  5 , Chien-Yu Lin  6 , Chun-Chih Peng  1   2
Affiliations
Meta-Analysis

Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis

Hung-Yang Chang et al. PLoS One. .

Abstract

Background: Some oral probiotics have been shown to prevent necrotizing enterocolitis (NEC) and decrease mortality effectively in preterm very low birth weight (PVLBW) infants. However, it is unclear whether a single probiotic or a mixture of probiotics is most effective for the prevention of NEC.

Objective: A meta-analysis was conducted by reviewing the most up to date literature to investigate whether multiple strains probiotics are more effective than a single strain in reducing NEC and death in PVLBW infants.

Data sources: Relevant studies were identified by searches of the MEDLINE, EMBASE, and Cochrane CENTRAL databases, from 2001 to 2016.

Data extraction and synthesis: The inclusion criteria were randomized controlled trials of any enteral probiotic supplementation that was initiated within the first 7 days and continued for at least 14 days in preterm infants (≤ 34 weeks' gestation) and/or those of a birth weight ≤1500 g.

Results: A total of 25 trials (n = 7345 infants) were eligible for inclusion in the meta-analysis using a fixed-effects model. Multiple strains probiotics were associated with a marked reduction in the incidence of NEC, with a pooled OR of 0.36 (95% CI, 0.24-0.53; P < .00001). Single strain probiotic using Lactobacillus species had a borderline effect in reducing NEC (OR of 0.60; 95% CI 0.36-1.0; P = .05), but not mortality. Multiple strains probiotics had a greater effectiveness in reducing mortality and were associated with a pooled OR of 0.58 (95% CI, 0.43-0.79; P = .0006). Trials using single strain of Bifidobacterium species and Saccharomyces boulardii did not reveal any beneficial effects in terms of reducing NEC or mortality.

Conclusion: This updated report found that multiple strains probiotics appear to be the most feasible and effective strategy for the prevention of NEC and reduction of mortality in PVLBW neonates. Further clinical trials should focus on which probiotic combinations are most effective.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart showing the selection of studies for inclusion in the meta-analysis.
Fig 2
Fig 2. Meta-analysis of the efficacy of probiotics associated with the risk of NEC in preterm infants.
Fig 3
Fig 3. Meta-analysis of the efficacy of probiotics associated with the risk of death in preterm infants.
See this image and copyright information in PMC

References

    1. Luig M, Lui K, NSW & ACT NICUS Group. Epidemiology of necrotizing enterocolitis-Part I: Changing regional trends in extremely preterm infants over 14 years. J Paediatr Child Health 2005; 41: 169–173. 10.1111/j.1440-1754.2005.00582.x - DOI - PubMed
    1. Fitzgibbons SC, Ching Y, Yu D, Carpenter J, Kenny M, Weldon C, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 2009; 44: 1072–1075. 10.1016/j.jpedsurg.2009.02.013 - DOI - PubMed
    1. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 2005; 115: 696–703. 10.1542/peds.2004-0569 - DOI - PubMed
    1. Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med 2007; 161: 583–590. 10.1001/archpedi.161.6.583 - DOI - PubMed
    1. Chen AC, Chung MY, Chang JH, Lin HC. Pathogenesis implication for necrotizing enterocolitis prevention in preterm very-low-birth-weight infants. J Pediatr Gastroenterol Nutr 2014; 58: 7–11. - PubMed

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