title: [Probiotic associations in the prevention of necrotising enterocolitis and the reduction of late-onset sepsis and neonatal mortality in preterm infants under 1,500g: A systematic review].
abstract: OBJECTIVE
  Necrotising enterocolitis (NEC) is one of the most common and serious acquired bowel diseases a premature newborn can face. This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500g.
  
  
  METHODS
  A systematic review of randomised controlled trials, between January 1980 and March 2014, on MEDLINE, the Cochrane Central Register of Controlled Trials, together with EMBASE, was carried out. Studies with infants <1500g or <34 weeks were selected, discarding those with Jadad scores lower than 4.
  
  
  RESULTS
  9 studies were selected for further investigation, pooling a total of 3521 newborns. Probiotics were found to reduce the NEC incidence (RR 0.39; 95%CI: 0.26-0.57) and mortality (RR 0.70; 95%CI: 0.52-0.93), with no difference to placebo regarding late-onset sepsis (RR 0.91; 95%CI: 0.78-1.06). Finally, when analysing the different strands, the use of a 2-probiotic combination (Lactobacillus acidophilus with Bifidobacterium bifidum) proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations (RR 0.32; 95%CI: 0.15-0.66, NNT 20; 95%CI: 12-50).
  
  
  CONCLUSIONS
  Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates. Moreover, the combination of 2 probiotics (Lactobacillus acidophilus with Bifidobacterium bifidum) seems to produce the greatest benefits. However, due to the differences in probiotic components and administration, it would be wise to perform a randomised controlled trial comparing different probiotic mixtures.
authors.affiliation: Facultad de Medicina, Universidad de Barcelona, Campus Clínic, Barcelona, Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España.
authors.forename: Benjamin James
authors.initials: BJ
authors.lastname: Baucells
authors.affiliation: Servicio de Neonatología, Hospital Clínic-Seu Maternitat, Barcelona, Departamento de Pediatría, Obstetricia y Ginecología y Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España.
authors.forename: Maria
authors.initials: M
authors.lastname: Mercadal Hally
authors.affiliation: Servicio de Neonatología, Hospital Clínic-Seu Maternitat, BCNatal, Universitat de Barcelona, Barcelona, España.
authors.forename: Airam Tenesor
authors.initials: AT
authors.lastname: Álvarez Sánchez
authors.affiliation: Servicio de Neonatología, Hospital Clínic-Seu Maternitat, BCNatal, Universitat de Barcelona, Barcelona, España. Electronic address: jfiguer@clinic.ub.es.
authors.forename: Josep
authors.initials: J
authors.lastname: Figueras Aloy
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D019936:Probiotics / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000401:mortality* / Q000517:prevention & control*
keywords: Enterocolitis necrosante; Late-onset sepsis; Mortalidad; Mortality; Necrotising enterocolitis; Neonatos de muy bajo peso; Premature infant; Prematuro; Probiotics; Probióticos; Sepsis tardía; Very-low birth weight infants