title: Effect of Bifidobacterium breve M-16V supplementation on fecal bifidobacteria in preterm neonates--a randomised double blind placebo controlled trial.
abstract: BACKGROUND
  Probiotic supplementation significantly reduces the risk of necrotising enterocolitis (NEC) and all cause mortality in preterm neonates. Independent quality assessment is important before introducing routine probiotic supplementation in this cohort.
  
  
  OBJECTIVE
  To assess product quality, and confirm that Bifidobacterium breve (B. breve) M-16V supplementation will increase fecal B. breve counts without adverse effects.
  
  
  METHODS
  Strain identity (16S rRNA gene sequencing), viability over 2 year shelf-life were confirmed, and microbial contamination of the product was ruled out. In a controlled trial preterm neonates (Gestation <33 weeks) ready to commence or on feeds for <12 hours were randomly allocated to either B. breve M-16V (3×109 cfu/day) or placebo (dextrin) supplementation until the corrected age 37 weeks. Stool samples were collected before (S1) and after 3 weeks of supplementation (S2) for studying fecal B. breve levels using quantitative PCR (Primary outcome). Secondary outcomes included total fecal bifidobacteria and NEC≥Stage II. Categorical and continuous outcomes were analysed using Chi-square and Mann-Whitney tests, and McNemar and Wilcoxon signed-rank tests for paired comparisons.
  
  
  RESULTS
  A total of 159 neonates (Probiotic: 79, Placebo: 80) were enrolled. Maternal and neonatal demographic characteristics were comparable between the groups. The proportion of neonates with detectable B. breve increased significantly post intervention: Placebo: [S1:2/66 (3%), S2: 25/66 (38%), p<0.001] Probiotic: [S1: 29/74 (40%), S2: 67/74 (91%), p<0.001]. Median S1 B. breve counts in both groups were below detection (<4.7 log cells x g(-1)), increasing significantly in S2 for the probiotic group (log 8.6) while remaining <4.7 log in the control group (p<0.001). There were no adverse effects including probiotic sepsis and no deaths. NEC≥Stage II occurred in only 1 neonate (placebo group).
  
  
  CONCLUSIONS
  B. breve M-16V is a suitable probiotic strain for routine use in preterm neonates.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trial Registry ACTRN 12609000374268.
authors.affiliation: Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia; Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patole
authors.affiliation: PathWest Laboratory Medicine WA, KEM Hospital for Women, Perth, Australia.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Keil
authors.affiliation: Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia.
authors.forename: Annie
authors.initials: A
authors.lastname: Chang
authors.affiliation: Women and Infants Research Foundation, KEM Hospital for Women, Perth, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nathan
authors.affiliation: Women and Infants Research Foundation, KEM Hospital for Women, Perth, Australia; School of Women's and Infants' Health, University of New South Wales, Sydney, Australia.
authors.forename: Dorota
authors.initials: D
authors.lastname: Doherty
authors.affiliation: Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia; Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Simmer
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Meera
authors.initials: M
authors.lastname: Esvaran
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Conway
mesh_terms: D001483:Base Sequence; D001644:Bifidobacterium / Q000235:genetics; D017931:DNA Primers; D004269:DNA, Bacterial / Q000235:genetics; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D005243:Feces / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control*; D007234:Infant, Premature; D016133:Polymerase Chain Reaction; D019936:Probiotics; D016896:Treatment Outcome
chemical_list: D017931:DNA Primers; D004269:DNA, Bacterial