Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis.
BACKGROUND
Some oral probiotics have been shown to prevent necrotizing enterocolitis (NEC) and decrease mortality effectively in preterm very low birth weight (PVLBW) infants. However, it is unclear whether a single probiotic or a mixture of probiotics is most effective for the prevention of NEC.


OBJECTIVE
A meta-analysis was conducted by reviewing the most up to date literature to investigate whether multiple strains probiotics are more effective than a single strain in reducing NEC and death in PVLBW infants.


METHODS
Relevant studies were identified by searches of the MEDLINE, EMBASE, and Cochrane CENTRAL databases, from 2001 to 2016.


METHODS
The inclusion criteria were randomized controlled trials of any enteral probiotic supplementation that was initiated within the first 7 days and continued for at least 14 days in preterm infants (≤ 34 weeks' gestation) and/or those of a birth weight ≤1500 g.


RESULTS
A total of 25 trials (n = 7345 infants) were eligible for inclusion in the meta-analysis using a fixed-effects model. Multiple strains probiotics were associated with a marked reduction in the incidence of NEC, with a pooled OR of 0.36 (95% CI, 0.24-0.53; P < .00001). Single strain probiotic using Lactobacillus species had a borderline effect in reducing NEC (OR of 0.60; 95% CI 0.36-1.0; P = .05), but not mortality. Multiple strains probiotics had a greater effectiveness in reducing mortality and were associated with a pooled OR of 0.58 (95% CI, 0.43-0.79; P = .0006). Trials using single strain of Bifidobacterium species and Saccharomyces boulardii did not reveal any beneficial effects in terms of reducing NEC or mortality.


CONCLUSIONS
This updated report found that multiple strains probiotics appear to be the most feasible and effective strategy for the prevention of NEC and reduction of mortality in PVLBW neonates. Further clinical trials should focus on which probiotic combinations are most effective.
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.|Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
Hung-Yang
HY
Chang
School of Public Health and Biostatistics Center, Taipei Medical University, Taipei, Taiwan.
Jin-Hua
JH
Chen
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Jui-Hsing
JH
Chang
Department of Pediatrics, Children's Hospital and School of Chinese Medicine, China Medical University, Taichung, Taiwan.
Hung-Chih
HC
Lin
Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu city, Taiwan.
Chien-Yu
CY
Lin
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
Chun-Chih
CC
Peng
D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D019936:Probiotics / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic