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Observational Study
. 2020 Mar 22;12(3):850.
doi: 10.3390/nu12030850.

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

Ingmar Fortmann  1 , Janina Marißen  1 , Bastian Siller  1 , Juliane Spiegler  1 , Alexander Humberg  1 , Kathrin Hanke  1 , Kirstin Faust  1 , Julia Pagel  1   2 , Leila Eyvazzadeh  1 , Kim Brenner  1 , Claudia Roll  3 , Sabine Pirr  4 , Dorothee Viemann  4 , Dimitra Stavropoulou  5 , Philipp Henneke  5   6 , Birte Tröger  7 , Thorsten Körner  7 , Anja Stein  8 , Christoph Derouet  9 , Michael Zemlin  9 , Christian Wieg  10 , Jan Rupp  2   11 , Egbert Herting  1 , Wolfgang Göpel  1 , Christoph Härtel  1   2
Affiliations
Observational Study

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

Ingmar Fortmann et al. Nutrients. .

Abstract

Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth.

Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models.

Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82-4.35; p < 0.001) but not in the F group (effect size B = -0.06; 95% CI: -3.05-0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59-0.79; p < 0.001).

Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

Keywords: growth failure; human milk; prematurity; probiotic prophylaxis; sepsis.

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Conflict of interest statement

The authors declare no conflict of interests. GNN is funded by the German Ministry for Education and Research. There has been no involvement in study design, collection of analysis, interpretation of data, writing of the report, and decision to submit the manuscript for publication by the German Ministry for Education and Research. The first version of the manuscript was written by Ingmar Fortmann and Christoph Härtel. No payment, honorarium, grant, or other form of payment has been given to the authors.

Figures

Figure 1
Figure 1
Changes in enteral feeding on German Neonatal Network (GNN) neonatal intensive care units (NICUs) between 2013 and 2018. HM, human milk; * includes all infants that were exposed to HM; ** includes all infants that were fed exclusively HM (own mother and/or donor).
See this image and copyright information in PMC

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