Lactobacillus reuteri DSM 17938 as a Probiotic for Preterm Neonates: A Strain-Specific Systematic Review

JPEN J Parenter Enteral Nutr. 2016 Aug;40(6):783-94. doi: 10.1177/0148607115588113. Epub 2015 Jun 9.


Introduction: 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.

Objective: To assess the effects of L reuteri in preterm neonates.

Design: 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.

Results: 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.

Conclusions: 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.

Keywords: enteral nutrition; life cycle; neonates; nutrition, probiotics; research and diseases.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Enteral Nutrition
  • Enterocolitis, Necrotizing / prevention & control
  • Gastrointestinal Motility
  • Gestational Age
  • Humans
  • Infant Nutritional Physiological Phenomena
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature*
  • Lactobacillus reuteri*
  • Probiotics / therapeutic use*
  • Treatment Outcome