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American Academy of Pediatrics
Review Article

Effects of Probiotics in Preterm Infants: A Network Meta-analysis

Cheng Chi, Cheng Li, Nicholas Buys, Wenjun Wang, Chenghong Yin and Jing Sun
Pediatrics January 2021, 147 (1) e20200706; DOI: https://doi.org/10.1542/peds.2020-0706
Cheng Chi
aSchool of Nursing, Jining Medical University, Jining, China;
bDepartment of Internal Medicine, Beijing Obstetrics and Gynecology Hospital and Capital Medical University, Beijing, China; and
cSchool of Medicine and
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Cheng Li
aSchool of Nursing, Jining Medical University, Jining, China;
bDepartment of Internal Medicine, Beijing Obstetrics and Gynecology Hospital and Capital Medical University, Beijing, China; and
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Nicholas Buys
dMenzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Wenjun Wang
aSchool of Nursing, Jining Medical University, Jining, China;
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Chenghong Yin
bDepartment of Internal Medicine, Beijing Obstetrics and Gynecology Hospital and Capital Medical University, Beijing, China; and
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Jing Sun
cSchool of Medicine and
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Abstract

CONTEXT: Probiotics have proven to be effective in promoting premature infants’ health, but the optimal usage is unknown.

OBJECTIVE: To compare probiotic supplements for premature infants.

DATA SOURCES: We searched PubMed, Embase, Cochrane, and ProQuest from inception of these databases to June 1, 2020.

STUDY SELECTION: Randomized trials of probiotic supplement intervention for preterm infants were screened by 2 reviewers independently. The primary outcomes were mortality and the morbidity of necrotizing enterocolitis (NEC). Secondary outcomes were morbidity of sepsis, time to achieve full enteral feeding, and length of hospital stay.

DATA EXTRACTION: The data of primary and secondary outcomes were extracted by 2 reviewers and pooled with a random-effects model.

RESULTS: The meta-analysis included 45 trials with 12 320 participants. 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) in comparison to the placebo; Lactobacillus plus prebiotic was associated with lower rates of NEC morbidity (0.06; 0.01–0.41) in comparison to the placebo; Bifidobacterium plus prebiotic had the highest probability of having the lowest rate of mortality (surface under the cumulative ranking curve 83.94%); and Lactobacillus plus prebiotic had the highest probability of having the lowest rate of NEC (surface under the cumulative ranking curve 95.62%).

LIMITATIONS: In few studies did authors report the data of infants with a lower birth weight or gestational age.

CONCLUSIONS: The efficacy of single probiotic supplements is limited, compared to combined use of probiotics. To achieve optimal effect on premature infant health, combined use of prebiotic and probiotic, especially Lactobacillus or Bifidobacterium, is recommended.

  • Accepted September 9, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 1
1 Jan 2021
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Effects of Probiotics in Preterm Infants: A Network Meta-analysis
Cheng Chi, Cheng Li, Nicholas Buys, Wenjun Wang, Chenghong Yin, Jing Sun
Pediatrics Jan 2021, 147 (1) e20200706; DOI: 10.1542/peds.2020-0706

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Effects of Probiotics in Preterm Infants: A Network Meta-analysis
Cheng Chi, Cheng Li, Nicholas Buys, Wenjun Wang, Chenghong Yin, Jing Sun
Pediatrics Jan 2021, 147 (1) e20200706; DOI: 10.1542/peds.2020-0706
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