title: Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis.
abstract: BACKGROUND
  Late-onset sepsis (LOS) is a major cause of mortality and morbidity in preterm infants. Despite various preventive measures, its incidence continues to remain high, hence the urgent need for additional approaches. One such potential strategy is supplementation with probiotics. The updated Cochrane Review (2014) did not find benefits of probiotics in reducing the risk of LOS in preterm infants (19 studies, N = 5338). Currently there are >30 randomized controlled trials (RCTs) of probiotics in preterm infants that have reported on LOS.
  
  
  OBJECTIVE
  To conduct a systematic review including all relevant RCTs.
  
  
  METHODS
  PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in June and August 2015.
  
  
  METHODS
  RCTs comparing probiotics versus placebo/no probiotic were included.
  
  
  METHODS
  Relevant data were extracted independently by 3 reviewers.
  
  
  RESULTS
  Pooled results from 37 RCTs (N = 9416) using fixed effects model meta analysis showed that probiotics significantly decreased the risk of LOS (675/4852 [13.9%] vs 744/4564 [16.3%]; relative risk, 0.86; 95% confidence interval, 0.78-0.94; P = .0007; I(2) = 35%; number needed to treat, 44). The results were significant even after excluding studies with high risk of bias.
  
  
  CONCLUSIONS
  Probiotic supplementation reduces the risk of LOS in preterm infants.
authors.affiliation: Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; Neonatal ICU, Princess Margaret Hospital for Children, Perth, Western Australia; Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia; shripada.rao@health.wa.gov.au.
authors.forename: Shripada C
authors.initials: SC
authors.lastname: Rao
authors.affiliation: Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; Neonatal ICU, Princess Margaret Hospital for Children, Perth, Western Australia; Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia;
authors.forename: Gayatri K
authors.initials: GK
authors.lastname: Athalye-Jape
authors.affiliation: Neonatal ICU, Nepean Hospital, Kingswood, NSW, Australia; and Sydney Medical School, Nepean, University of Sydney, Australia.
authors.forename: Girish C
authors.initials: GC
authors.lastname: Deshpande
authors.affiliation: Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; Neonatal ICU, Princess Margaret Hospital for Children, Perth, Western Australia; Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia;
authors.forename: Karen N
authors.initials: KN
authors.lastname: Simmer
authors.affiliation: Neonatal ICU, King Edward Memorial Hospital for Women, Perth, Western Australia; Centre for Neonatal Research and Education, School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia;
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Patole
mesh_terms: D019587:Dietary Supplements; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D019936:Probiotics / Q000627:therapeutic use*; D018805:Sepsis / Q000517:prevention & control*