title: Prebiotic supplementation in preterm neonates: updated systematic review and meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Regular administration of prebiotic oligosaccharides promote beneficial gut flora in infants. We aimed to systematically review randomized controlled trials evaluating the safety and efficacy of prebiotic oligosaccharide supplementation in preterm infants ≤ 37 weeks of gestation.
  
  
  METHODS
  Available studies from Medline, Embase, comparing formula milk supplemented with or without prebiotics, reporting on safety and the incidence of necrotising enterocolitis (NEC), late onset sepsis, feed tolerance, physical growth and various stool characteristics were eligible.
  
  
  RESULTS
  7 trials (n = 417) were included. Five trials (n = 345) reported on the incidence of NEC, 3 trials (n = 295) reported on the incidence of late onset sepsis. Meta-analysis revealed a pooled RR (95% CI) of 1.24 (0.56-2.72) for NEC, 0.81 (0.57-1.15), p 0.23 for the risk of late onset sepsis. 3 individual trials (n = 295) did not observe any improvement in time to enteral feeds post intervention. Meta-analysis indicated a statistically significant difference in the growth of bifidobacteria in the oligosaccharide group with a weighted mean difference of 0.53 (95% CI: 0.33, 0.73) *10(6) colonies/g, p < 0.00001. A reduction in stool viscosity and pH was also observed. None of the trials reported life threatening adverse effects.
  
  
  CONCLUSIONS
  Supplementation with prebiotic oligosaccharides was safe and did not result in decreased incidence of NEC, late onset sepsis and time to full enteral feeds but resulted in a significantly higher growth of beneficial microbes.
authors.affiliation: Department of Neonatology and Paediatrics, Joondalup Health Campus and Joondalup Child Development Centre, Joondalup, Western Australia, Australia; Department of Neonatology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. Electronic address: msravish@yahoo.com.
authors.forename: Ravisha
authors.initials: R
authors.lastname: Srinivasjois
authors.forename: Shripada
authors.initials: S
authors.lastname: Rao
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patole
mesh_terms: D001644:Bifidobacterium; D019587:Dietary Supplements; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D005243:Feces / Q000382:microbiology; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D009844:Oligosaccharides / Q000008:administration & dosage; D056692:Prebiotics; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D018805:Sepsis / Q000517:prevention & control
chemical_list: D009844:Oligosaccharides; D056692:Prebiotics
keywords: Bifidobacteria; Enteral feeds; Lactobacillus; Necrotising enterocolitis; Prebiotic oligosaccharides; Sepsis