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Review
, 85 (5), 247-255

[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]

[Article in Spanish]
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Review

[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]

[Article in Spanish]
Benjamin James Baucells et al. An Pediatr (Barc).

Abstract

Introduction and 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.

Material and 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.

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.

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