Probiotics for Preterm Infants: Which One(s) to Choose?

Ravi Mangal Patel; Mohan Pammi

doi:10.1542/peds.2020-039735

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Abbreviations:

NEC —: necrotizing enterocolitis
NMA —: network meta-analysis
SUCRA —: surface under the cumulative ranking curve

Necrotizing enterocolitis (NEC) and sepsis are major causes of mortality among preterm infants.^1,2 Microbial dysbiosis or imbalance in the preterm gut may predispose to NEC, and optimizing the gut microbiome with probiotics is a promising strategy to prevent NEC.³ Multiple previous meta-analyses have reported that enteral supplementation with probiotics, compared to placebo, reduces the risks of NEC, sepsis, and mortality.⁴ Prebiotics, which support the growth or activity of beneficial bacteria, may also reduce the risks of sepsis and mortality.⁵ However, there is uncertainty regarding the relative efficacy of different types of probiotics, prebiotics, or synbiotics (combinations of the 2) in preventing morbidity or mortality in preterm infants.

In this issue of Pediatrics, Chi et al⁶ present a systematic review and network meta-analysis (NMA) evaluating the effects of probiotics and synbiotics in preterm infants.

The protocol for the systematic review was preregistered, and trials in which authors evaluated both probiotics and synbiotics in preterm infants were searched. The primary outcomes were all-cause mortality and NEC. An NMA was performed …

Address correspondence to Ravi Mangal Patel, MD, MSc, Emory Children’s Center, 2015 Uppergate Dr NE, Atlanta, GA 30322. E-mail: rmpatel{at}emory.edu