title: Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis.
abstract: OBJECTIVE
  To determine the effect of dual-strain probiotics on the development of necrotizing enterocolitis (NEC), mortality and nosocomial bloodstream infections (BSI) in preterm infants in German neonatal intensive care units (NICUs).
  
  
  METHODS
  A multi-center interrupted time series analysis.
  
  
  METHODS
  44 German NICUs with routine use of dual-strain probiotics on neonatal ward level.
  
  
  METHODS
  Preterm infants documented by NEO-KISS, the German surveillance system for nosocomial infections in preterm infants with birth weights below 1,500 g, between 2004 and 2014.
  
  
  METHODS
  Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level.
  
  
  METHODS
  Incidences of NEC, overall mortality, mortality following NEC and nosocomial BSI.
  
  
  RESULTS
  Data from 10,890 preterm infants in 44 neonatal wards was included in this study. Incidences of NEC and BSI were 2.5% (n = 274) and 15.0%, (n = 1631), respectively. Mortality rate was 6.1% (n = 665). The use of dual-strain probiotics significantly reduced the risk of NEC (HR = 0.48; 95% CI = 0.38-0.62), overall mortality (HR = 0.60, 95% CI = 0.44-0.83), mortality after NEC (HR = 0.51, 95% CI = 0.26-0.999) and nosocomial BSI (HR = 0.89, 95% CI = 0.81-0.98). These effects were even more pronounced in the subgroup analysis of preterm infants with birth weights below 1,000 g.
  
  
  CONCLUSIONS
  In order to reduce NEC and mortality in preterm infants, it is advisable to add routine prophylaxis with dual-strain probiotics to clinical practice in neonatal wards.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Luisa A
authors.identifier: http://orcid.org/0000-0003-4005-1315
authors.initials: LA
authors.lastname: Denkel
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Garten
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Geffers
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Brar
authors.initials: B
authors.lastname: Piening
mesh_terms: D003428:Cross Infection / Q000188:drug therapy; D020345:Enterocolitis, Necrotizing / Q000188:drug therapy; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D065186:Interrupted Time Series Analysis; D008297:Male; D019936:Probiotics / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D020011:Protective Agents / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D020011:Protective Agents