PEDIATRICS Vol. 115 No. 1 January 2005, pp. 1-4 (doi:10.1542/peds.2004-1463)
Oral Probiotics Reduce the Incidence and Severity of Necrotizing Enterocolitis in Very Low Birth Weight Infants
* Department of Pediatrics, China Medical University Hospital, China Medical University, Taichung, Taiwan
Taichung Healthcare and Management University, Taichung, Taiwan
Department of Pediatrics, Brown Medical School, Providence, Rhode Island
Objective. We evaluated the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.
Patients and Methods. A prospective, masked, randomized control trial was conducted to evaluate the beneficial effects of probiotics in reducing the incidence and severity of NEC among VLBW (<1500 g) infants. VLBW infants who started to fed enterally and survived beyond the seventh day after birth were eligible for the trial. They were randomized into 2 groups after parental informed consents were obtained. The infants in the study group were fed with Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) with breast milk twice daily until discharged. Infants in the control group were fed with breast milk alone. The clinicians caring for the infants were blinded to the group assignment. The primary outcome was death or NEC (
stage 2).
Results. Three hundred sixty-seven infants were enrolled: 180 in the study group and 187 in the control group. The demographic and clinical variables were similar in both groups. The incidence of death or NEC ( stage 2) was significantly lower in the study group (9 of 180 vs 24 of 187). The incidence of NEC ( stage 2) was also significantly lower in the study when compared with the control group (2 of 180 vs 10 of 187). There were 6 cases of severe NEC (Bell stage 3) in the control group and none in the study group. None of the positive blood culture grew Lactobacillus or Bifidobacterium species.
Conclusion. Infloran as probiotics fed enterally with breast milk reduces the incidence and severity of NEC in VLBW infants.
Key Words: probiotics • necrotizing enterocolitis • sepsis • mortality • very low birth weight infants
Abbreviations: NEC, necrotizing enterocolitis • VLBW, very low birth weight
Accepted Sep 23, 2004.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  F. Abdullah, Y. Zhang, M. Camp, D. Mukherjee, A. Gabre-Kidan, P. M. Colombani, and D. C. Chang Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical Treatments Clinical Pediatrics, March 1, 2010; 49(2): 166 - 171. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Drenckpohl, L. Knaub, C. Schneider, C. McConnell, Huaping Wang, and K. Macwan Risk Factors That May Predispose Premature Infants to Increased Incidence of Necrotizing Enterocolitis ICAN: Infant, Child, & Adolescent Nutrition, February 1, 2010; 2(1): 37 - 44. [Abstract] [PDF]
|
|
|
|
|
|
T. Anderson, A. Lord, N. Shotkoski, and C. O'Keefe The Use of Probiotics for the Prevention of Necrotizing Enterocolitis in the Premature Infant ICAN: Infant, Child, & Adolescent Nutrition, October 1, 2009; 1(5): 246 - 252. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Liu, L. Zhu, N. Y. Fatheree, X. Liu, S. E. Pacheco, N. Tatevian, and J. M. Rhoads Changes in intestinal Toll-like receptors and cytokines precede histological injury in a rat model of necrotizing enterocolitis Am J Physiol Gastrointest Liver Physiol, September 1, 2009; 297(3): G442 - G450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rouge, H. Piloquet, M.-J. Butel, B. Berger, F. Rochat, L. Ferraris, C. Des Robert, A. Legrand, M.-F. de la Cochetiere, J.-M. N'Guyen, et al. Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial Am. J. Clinical Nutrition, June 1, 2009; 89(6): 1828 - 1835. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Samanta, M. Sarkar, P. Ghosh, J. k. Ghosh, M. k. Sinha, and S. Chatterjee Prophylactic Probiotics for Prevention of Necrotizing Enterocolitis in Very Low Birth Weight Newborns J Trop Pediatr, April 1, 2009; 55(2): 128 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Hunter, M. Williams, M. Petrosyan, Y. Guner, R. Mittal, D. Mock, J. S. Upperman, H. R. Ford, and N. V. Prasadarao Lactobacillus bulgaricus Prevents Intestinal Epithelial Cell Injury Caused by Enterobacter sakazakii-Induced Nitric Oxide both In Vitro and in the Newborn Rat Model of Necrotizing Enterocolitis Infect. Immun., March 1, 2009; 77(3): 1031 - 1043. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Imhoff and K. Karpa Is There a Future for Probiotics in Preventing Clostridium difficile-Associated Disease and Treatment of Recurrent Episodes? Nutr Clin Pract, February 1, 2009; 24(1): 15 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Knapp, L. A. Thompson, W. B. Vogel, V. L. Madden, and E. A. Shenkman Developing a Pediatric Palliative Care Program: Addressing the Lack of Baseline Expenditure Information American Journal of Hospice and Palliative Medicine, February 1, 2009; 26(1): 40 - 46. [Abstract] [PDF]
|
|
|
|
 |
|
 S. C. Gribar, C. P. Sodhi, W. M. Richardson, R. J. Anand, G. K. Gittes, M. F. Branca, A. Jakub, X.-h. Shi, S. Shah, J. A. Ozolek, et al. Reciprocal Expression and Signaling of TLR4 and TLR9 in the Pathogenesis and Treatment of Necrotizing Enterocolitis J. Immunol., January 1, 2009; 182(1): 636 - 646. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-C. Lin, C.-H. Hsu, H.-L. Chen, M.-Y. Chung, J.-F. Hsu, R.-i. Lien, L.-Y. Tsao, C.-H. Chen, and B.-H. Su Oral Probiotics Prevent Necrotizing Enterocolitis in Very Low Birth Weight Preterm Infants: A Multicenter, Randomized, Controlled Trial Pediatrics, October 1, 2008; 122(4): 693 - 700. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. N. Lafeber, E. A. M. Westerbeek, A. van den Berg, W. P. F. Fetter, and R. M. van Elburg Nutritional Factors Influencing Infections in Preterm Infants J. Nutr., September 1, 2008; 138(9): 1813S - 1817S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Siggers, J. Siggers, M. Boye, T. Thymann, L. Molbak, T. Leser, B. B. Jensen, and P. T. Sangild Early Administration of Probiotics Alters Bacterial Colonization and Limits Diet-Induced Gut Dysfunction and Severity of Necrotizing Enterocolitis in Preterm Pigs J. Nutr., August 1, 2008; 138(8): 1437 - 1444. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Soltau and R. L. Schelonka Immune Modification to Prevent Nosocomial Sepsis in Hospitalized Newborns NeoReviews, May 1, 2008; 9(5): e199 - e205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Eichenwald and A. R. Stark Management and Outcomes of Very Low Birth Weight N. Engl. J. Med., April 17, 2008; 358(16): 1700 - 1711. [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Siggers, T. Thymann, B. B. Jensen, L. Molbak, P. M. H. Heegaard, M. Schmidt, R. K. Buddington, and P. T. Sangild Elective cesarean delivery affects gut maturation and delays microbial colonization but does not increase necrotizing enterocolitis in preterm pigs Am J Physiol Regulatory Integrative Comp Physiol, March 1, 2008; 294(3): R929 - R938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Guarner Studies with Inulin-Type Fructans on Intestinal Infections, Permeability, and Inflammation J. Nutr., November 1, 2007; 137(11): 2568S - 2571S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Veereman Pediatric Applications of Inulin and Oligofructose J. Nutr., November 1, 2007; 137(11): 2585S - 2589S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Isakow, L. E. Morrow, and M. H. Kollef Probiotics for Preventing and Treating Nosocomial Infections: Review of Current Evidence and Recommendations Chest, July 1, 2007; 132(1): 286 - 294. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. D. Karpa Probiotics for Clostridium difficile Diarrhea: Putting It into Perspective Ann. Pharmacother., July 1, 2007; 41(7): 1284 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Shenkman, C. Knapp, D. Sappington, B. Vogel, and D. Schatz Persistence of High Health Care Expenditures among Children in Medicaid Med Care Res Rev, June 1, 2007; 64(3): 304 - 330. [Abstract] [PDF]
|
|
|
|
|
|
J. M. Saavedra Use of Probiotics in Pediatrics: Rationale, Mechanisms of Action, and Practical Aspects Nutr Clin Pract, June 1, 2007; 22(3): 351 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Neu, M. Douglas-Escobar, and M. Lopez Microbes and the Developing Gastrointestinal Tract Nutr Clin Pract, April 1, 2007; 22(2): 174 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Neu Gastrointestinal development and meeting the nutritional needs of premature infants Am. J. Clinical Nutrition, February 1, 2007; 85(2): 629S - 634S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Pietz, B. Achanti, L. Lilien, E. C. Stepka, and S. K. Mehta Prevention of Necrotizing Enterocolitis in Preterm Infants: A 20-Year Experience Pediatrics, January 1, 2007; 119(1): e164 - e170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. T. Sangild Gut Responses to Enteral Nutrition in Preterm Infants and Animals Exp Biol Med, December 1, 2006; 231(11): 1695 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Hammerman, A. Bin-Nun, and M. Kaplan Safety of probiotics: comparison of two popular strains BMJ, November 11, 2006; 333(7576): 1006 - 1008. [Full Text] [PDF]
|
|
|
|
 |
|
 R J Schanler Probiotics and necrotising enterocolitis in premature infants. Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2006; 91(6): F395 - F397. [Full Text] [PDF]
|
|
|
|
|
|
T. Jilling, D. Simon, J. Lu, F. J. Meng, D. Li, R. Schy, R. B. Thomson, A. Soliman, M. Arditi, and M. S. Caplan The Roles of Bacteria and TLR4 in Rat and Murine Models of Necrotizing Enterocolitis. J. Immunol., September 1, 2006; 177(5): 3273 - 3282. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Roy, C. L. Kien, L. Bouthillier, and E. Levy Short-Chain Fatty Acids: Ready for Prime Time? Nutr Clin Pract, August 1, 2006; 21(4): 351 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Cabana, A. L. Shane, C. Chao, and M. Oliva-Hemker Probiotics in Primary Care Pediatrics Clinical Pediatrics, June 1, 2006; 45(5): 405 - 410. [Abstract] [PDF]
|
|
|
|
|
|
N. Jesse and J. Neu Necrotizing Enterocolitis: Relationship to Innate Immunity, Clinical Features, and Strategies for Prevention NeoReviews, March 1, 2006; 7(3): e143 - e150. [Full Text] [PDF]
|
|
|
|
|
|
D. R. Mack Probiotics and Necrotizing Enterocolitis Pediatrics, July 1, 2005; 116(1): 293 - 293. [Full Text] [PDF]
|
|
|
|
 |
|
 Journal Watch Arch. Dis. Child., May 1, 2005; 90(5): 544 - 545. [Full Text] [PDF]
|
|
|
|
|
|
D. K. Ng, C.-h. Chan, P.-y. Chow, and K.-l. Kwok Possible Confounding Factors in an Oral Probiotics Trial: Breast Milk Pediatrics, May 1, 2005; 115(5): 1442 - 1443. [Full Text] [PDF]
|
|
|
|
 |
|
 Probiotics for Infants: Two Studies, Two Successes Journal Watch (General), February 11, 2005; 2005(211): 3 - 3. [Full Text]
|
|
|
|
 |
|
 Probiotics in Infants: Two Studies, Two Successes Journal Watch Pediatrics and Adolescent Medicine, February 1, 2005; 2005(201): 2 - 2. [Full Text]
|
|
|
|
|
|
R. M. Kliegman and R. E. Willoughby Prevention of Necrotizing Enterocolitis With Probiotics Pediatrics, January 1, 2005; 115(1): 171 - 172. [Full Text] [PDF]
|
|
|
|
|
|
E. F. Bell Preventing Necrotizing Enterocolitis: What Works and How Safe? Pediatrics, January 1, 2005; 115(1): 173 - 174. [Full Text] [PDF]
|
|
