NICU probiotics supress risk of NEC, death

The use of probiotics in neonatal intensive care units (NICUs) appear to be increasing over time and may be protective against necrotizing enterocolitis (NEC) and death, a recent study has found.

The researchers performed a multicentre cohort study including 78,076 infants (gestational age, 23–29 weeks) admitted to a NICU from 1997–2016. The change in probiotic exposure over time, as well as the likelihood of outcomes such as NEC, death, bloodstream infections, and meningitis, were all evaluated.

Of the enrolled infants, 4.6 percent (n=3,626) were given probiotics in the NICU. The most commonly used probiotic was Lactobacillus (71 percent), followed by Ultimate Flora (containing species of Bifidobacterium and Lactobacillus).

Probiotic use showed an increasing trend over time. In 1997, at the start of data collection, none of the included NICUs administered probiotics. This picked up only between 1998 and 2000, gradually growing in number and showing spikes in 2006 and 2014. By 2016, 118 infants were exposed to probiotics per 1,000 admissions.

Compared to non-exposed infants, the risk of NEC was significantly lower in infants who had been given probiotics, according to conditional logistic regression analysis (odds ratio [OR], 0.62, 95 percent confidence interval [CI], 0.48–0.80; p<0.001). The same was true for the risk of death (OR, 0.52, 95 percent CI, 0.39–0.70; p<0.001).

On the other hand, probiotics appeared to increase the risk of Candida infections (OR, 2.23, 95 percent CI, 1.29–3.85; p=0.004). No such effects were found for bloodstream infections or meningitis.