Probiotics for Low Birth Weight Infants

Necrotizing enterocolitis (NEC) is a significant cause of death for low birth weight premature infants.

NEC means abdominal distension,  vomiting, bloody diarrhea, and bradycardia; it is reported in 10 to 25% of preterm infants and may affect 1/3 to1/2 of all low birth weight infants. The mortality ranges from 20 to 30% and those who survive may have long term complications including short gut syndrome, intestinal obstruction and multi-organ failure.

Low birth weight pre-term infants delivered by Caesarean section often require intensive care and are breast fed only after several days. The normal process by which organisms such as lactobacillus species are ingested via vaginal birth and propagated by mother’s milk does not take place in these infants. Therefore these infants are exposed to  pathogenic microbes which colonize the intestine and increase the risk of NEC. Furthermore, pre-term infants given formula feeding have fewer lactobacillus and bifidobacterium species in their stool compared to controls. These findings suggest a correlation between NEC and lactobacillus species.

In a meta-analysis done at King Saud Hospital in Saudia Arabia,  probiotics supplementation significantly reduced the incidence of severe NEC and mortality.

A human trial with strains of lactobacillus and bifidobacterium  given to 1237 newborns in  Columbia, resulted in 60% reduction in NEC and overall mortality.

In a 2010 report ,  researchers at Charite University Hospital in Berlin, Germany concluded “Best results appear to be achieved with probiotics based on 2 or more probiotic species and/or with a combination of Bifidusbacterium spp. and Lactobacillus acidophilus. No unwanted side effects have been reported among 1,117 infants randomized to receive probiotics. We conclude that probiotics are safe and beneficial in preterm infants at risk for NEC.”

Indeed reviews of randomized controlled trials suggest that  that probiotics significantly reduce the risk of NEC and all-cause mortality while facilitating enteral feeds in preterm infants. Researchers from Australia report in Neonatology journal that data from 25 trials and reports on routine use  indicate that significant adverse effects of probiotics are rare. But they also report that in spite of the robust evidence, there is reluctance in using  probiotics in clinical practice.

Many clinicians worldwide are asking if it is time to use probiotics routinely in NEC.