title: Prophylactic use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics and outcome in very low birth weight infants.
abstract: OBJECTIVE
  To evaluate outcome data in an observational cohort of very low birth weight infants of the German Neonatal Network stratified to prophylactic use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics.
  
  
  METHODS
  Within the observational period (September 1, 2010, until December 31, 2012, n=5351 infants) study centers were categorized into 3 groups based on their choice of Lactobacillus acidophilus/Bifidobacterium infantis use: (1) no prophylactic use (12 centers); (2 a/b) change of strategy nonuser to user during observational period (13 centers); and (3) use before start of observation (21 centers). Primary outcome data of all eligible infants were determined according to center-specific strategy.
  
  
  RESULTS
  The use of probiotics was associated with a reduced risk for necrotizing enterocolitis surgery (group 1 vs group 3: 4.2 vs 2.6%, P=.028; change of strategy: 6.2 vs 4.0%, P<.001), any abdominal surgery, and hospital mortality. Infants treated with probiotics had improved weight gain/day, and probiotics had no effect on the risk of blood-culture confirmed sepsis. In a multivariable logistic regression analysis, probiotics were protective for necrotizing enterocolitis surgery (OR 0.58, 95% CI 0.37-0.91; P=.017), any abdominal surgery (OR 0.7, 95% CI 0.51-0.95; P=.02), and the combined outcome abdominal surgery and/or death (OR 0.43; 95% CI 0.33-0.56; P<.001).
  
  
  CONCLUSIONS
  Our observational data support the use of Lactobacillus acidophilus/Bifidobacterium infantis probiotics to reduce the risk for gastrointestinal morbidity but not sepsis in very low birth weight infants.
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany. Electronic address: christoph.haertel@uksh.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Pagel
authors.affiliation: Institute for Medical Microbiology and Hygiene of the University at Lübeck, Lübeck, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Rupp
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Bendiks
authors.affiliation: Department of Neonatology, University of Tübingen, Tübingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Guthmann
authors.affiliation: Children's Hospitals Hannover Auf der Bult, Hannover, Germany.
authors.forename: Esther
authors.initials: E
authors.lastname: Rieger-Fackeldey
authors.affiliation: Department of Pediatrics at University of Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heckmann
authors.affiliation: Department of Pediatrics, University of Greifswald, Greifswald, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Franz
authors.affiliation: Children's Hospital (Städtisches Klinikum) Nürmberg, Nürnberg, Germany.
authors.forename: Jan-Holger
authors.initials: JH
authors.lastname: Schiffmann
authors.affiliation: Department of Pediatrics, GFO Hospitals Bonn, St. Marien Hospital, Bonn, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Zimmermann
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Hepping
authors.affiliation: Department of Neonatology, Children's Hospital Hamburg-Altona, Hamburg-Altona, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: von der Wense
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Aschaffenburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wieg
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany.
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.affiliation: Department of Pediatrics, University at Lübeck, Lübeck, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel
mesh_terms: D001644:Bifidobacterium; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D019102:Infant, Very Low Birth Weight; D007779:Lactobacillus acidophilus; D008297:Male; D019936:Probiotics / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome