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. 2022 Feb;11(2):249-259.
doi: 10.21037/tp-22-27.

Safety and efficacy of probiotics in the prevention of necrotizing enterocolitis in premature and/or low-birthweight infants: a systematic review and meta-analysis

Hua Liu #  1 , Bin Wang #  2 , Tiantian Lu  1 , Yuying Pei  3
Affiliations

Safety and efficacy of probiotics in the prevention of necrotizing enterocolitis in premature and/or low-birthweight infants: a systematic review and meta-analysis

Hua Liu et al. Transl Pediatr. 2022 Feb.

Abstract

Background: Neonatal necrotizing enterocolitis (NEC) is a serious pediatric gastrointestinal disease and a cause of death in neonates, especially in premature infants. The addition of probiotics to the diet can reduce the incidence and severity of neonatal NEC. This meta-analysis explored the preventive effect of probiotics on NEC.

Methods: Endnote X9 software was used to search for relevant studies in the Ovid, Embase, PubMed, and Web of Science databases. The search terms were "probiotics" and "necrotizing enterocolitis". After retrieval, screening, and quality evaluation of the studies, Stata 16.0 software was used to analyze the data.

Results: A total of 10 studies, which collectively included 3,227 patients, were selected for analysis. Of them, 5 used a multiple-strain probiotics, and 5 used single-strain probiotic. Meta-analysis showed that treatment with probiotics could reduce the incidence of severe NEC [risk ratio (RR) =0.66; 95% confidence interval (CI): (0.50, 0.87); Z=-2.978; P=0.003], reduce mortality in underweight premature children [RR =0.81; 95% CI: (0.70, 0.94); Z=-2.864; P=0.004], and reduce the incidence of feeding intolerance [RR =0.78; 95% CI: (0.67, 0.90); Z=-3.280; P=0.001].

Discussion: The addition of probiotics to the diet of low-birthweight and premature infants can reduce the incidence of severe NEC and reduce related mortality rates.

Keywords: Probiotics; low-birthweight infants; meta-analysis; necrotizing enterocolitis; preterm infants.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-27/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Literature search and screening process flow chart. RCT, randomized controlled trial.
Figure 2
Figure 2
Preventive effect of probiotics on severe NEC (12-18). NEC, neonatal necrotizing enterocolitis; CI, confidence interval.
Figure 3
Figure 3
Effect of probiotics on reducing mortality in underweight neonates (11-20). CI, confidence interval.
Figure 4
Figure 4
Effect of probiotics on reducing the overall incidence of NEC (11,17,19,20). NEC, neonatal necrotizing enterocolitis; CI, confidence interval.
Figure 5
Figure 5
Effect of probiotics on feeding intolerance (15,16,18). CI, confidence interval.
Figure 6
Figure 6
Heterogeneity analysis for mortality.
Figure 7
Figure 7
Sensitivity analysis for mortality (11-20). CI, confidence interval.
Figure 8
Figure 8
Funnel plot analysis of bias for mortality.
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