title: Lactobacillus reuteri DSM 17938 as a Probiotic for Preterm Neonates: A Strain-Specific Systematic Review.
abstract: Prevention of necrotizing enterocolitis (NEC) while optimizing enteral nutrition (EN) is a priority in preterm neonates. Lactobacillus reuteri DSM 17938 (L reuteri) is known to improve gut motility. Previous systematic reviews have not adequately assessed the effects of L reuteri in improving feed tolerance in preterm neonates.
  
  
  
  To assess the effects of L reuteri in preterm neonates.
  
  
  
  A systematic review of randomized controlled trials (RCTs) and non-RCTs of L reuteri was conducted. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL databases and proceedings of Pediatric Academic Society meetings in December 2014.
  
  
  
  Six RCTs (n = 1778) and 2 non-RCTs (n = 665) were included. Meta-analysis of RCTs estimated that the time to full feeds (mean difference [MD], -1.34 days; 95% confidence interval [CI], -1.81 to -0.86; 2 RCTs), duration of hospitalization (-10.77 days; 95% CI, -13.67 to -7.86; 3 RCTs), and late-onset sepsis (LOS) (relative risk [RR], 0.66; 95% CI, 0.52 to 0.83; 4 RCTs) were reduced in the L reuteri group. Mortality (RR, 0.79; 95% CI, 0.57-1.09; 3 RCTs) and ≥ stage II NEC (RR, 0.69; 95% CI, 0.47-1.01; 3 RCTs) were reduced but statistically not significant. There were no adverse effects of supplementation. Both non-RCT studies showed significant improvement in the incidence of NEC with L reuteri supplementation.
  
  
  
  Evidence from a limited number of studies suggests that L reuteri supplementation has the potential to reduce the risk of NEC and LOS while facilitating EN in preterm infants. Larger definitive RCTs are needed to confirm these findings.
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Athalye-Jape
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia.
authors.forename: Shripada
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia sanjay.patole@health.wa.gov.au.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Patole
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D005769:Gastrointestinal Motility; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D052200:Limosilactobacillus reuteri; D019936:Probiotics / Q000627:therapeutic use*; D016896:Treatment Outcome
keywords: enteral nutrition; life cycle; neonates; nutrition, probiotics; research and diseases