Bifidobacterium, Lactobacillus plus prebiotic recommended

Results from a network meta-analysis suggested that the combined use of probiotics and prebiotics outperformed use of probiotic supplements alone in promoting good health in preterm infants — and a combination of either Bifidobacterium or Lactobacillus plus prebiotic supplements was particularly effective, researchers reported.

Due to a combination of environmental factors and increased use of in vitro fertilization, the prevalence of preterm birth is high, Cheng Chi, PhD, Jining Medical University, Jining, China, and colleagues explained in Pediatrics. According to the World Health Organization, the rate of preterm birth ranges from 5% to 18% across 184 countries, with an estimated 15 million babies born preterm annually across the globe. These infants have immature immune systems and gastrointestinal tracts that are at risk for complications associated with premature birth, including neonatal death. An alteration in the infants’ gut microbiota as a result of preterm birth could be a factor that puts infants at risk of developing necrotizing enterocolitis (NEC) and sepsis.

While breast milk offers the best nutrition for newborn infants, some mothers cannot provide enough of it for preterm infants, which means that these newborns may need formula or other preparations as a nutrition supplement — and in such cases, probiotics could play a role in promoting the infant’s health.

“Early probiotic supplementation may benefit premature infants by improving their gastrointestinal tolerance against potential pathogens and regulating the altered gut microbiota to resemble that of a term healthy infant,” Chi and colleagues observed.

In their network meta-analysis, the authors evaluated the effects of probiotics on premature infants and attempted to determine the best intervention for optimizing premature infant health.

The study authors included 45 randomized trials with 12,320 participants. The primary outcomes were mortality and necrotizing enterocolitis (NEC) morbidity, and the secondary outcomes included sepsis morbidity, length of hospital stay, and the time to achieve full enteral feeding.

Regarding the primary outcomes, Chi and colleagues found:

  • Bifidobacterium plus Lactobacillus was associated with lower rates of mortality (risk ratio 0.56; 95% credible interval 0.34-0.84) and NEC morbidity (0.47; 0.27-0.79) compared to placebo.
  • Lactobacillus plus prebiotic was associated with lower rates of NEC morbidity (0.06; 0.01-0.41) compared to placebo.
  • Bifidobacterium plus prebiotic had the highest probability of having the lowest rate of mortality (surface under the cumulative ranking curve [SUCRA] 83.94%).
  • Lactobacillus plus prebiotic had the highest probability of having the lowest rate of NEC (surface under the cumulative ranking curve 95.62%).

Chi and colleagues also found that Lactobacillus plus prebiotic was associated with lower rates of NEC morbidity and sepsis morbidity than the rates associated with Bifidobacterium plus Lactobacillus. Regarding the time to full enteral feeding, Lactobacillus plus prebiotic was also superior to Bifidobacterium plus Lactobacillus.

“The results suggest that the rates of mortality, NEC morbidity, and sepsis morbidity, as well as the time to full enteral feeding and length of hospital stay, may be reduced by combined use of any two of Lactobacillus, Bifidobacterium, and prebiotic,” the authors wrote.

The value of this study, Chi and colleagues noted, is the fact that while previous pairwise meta-analyses focused on the efficacy of probiotics, this meta-analysis provided evidence on which strains and methods researchers should use when designing studies to give premature infants individualized, precise nutritional interventions. The results of the study, they added, suggest that in order in order to optimize the health of premature infants, “combined use of prebiotic and probiotic, especially Lactobacillus or Bifidobacterium, is recommended in further study design.”

In a commentary accompanying the study, Ravi Mangal Patel, MD, MSc, Emory Children’s Center, Atlanta, observed that network meta-analyses and SUCRA rankings have limitations that need to be considered in interpreting the findings by Chi et al.

For example, SUCRA rankings may be misleading if they include studies with a high risk of bias. Additionally, they may be outcome dependent and don’t consider the magnitude of differences in effects between treatments or the possibility of chance findings. “Therefore, the rankings of various treatments in the study by Chi et al should be interpreted with caution,” Patel wrote.

While the meta-analysis provides additional evidence that supports the potential benefits of giving probiotics to preterm infants in order to reduce the risks of NEC, death, and late-onset sepsis, Chi concluded, its findings also “highlight the need for additional studies by researchers to determine if synbiotics are superior to probiotics for use in preterm infants and how human milk intake, which is a source of prebiotics, may influence the treatment effects of different probiotics strains.”

  1. The combined use of probiotics and prebiotics is recommended to promote the health of preterm infants.

  2. A combination of either Bifidobacterium or Lactobacillus plus prebiotic supplements is particularly recommended.

Michael Bassett, Contributing Writer, BreakingMED™

None of the authors cited in this article disclosed any relevant relationships.

Cat ID: 138

Topic ID: 85,138,730,41,138,192,925