Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2016 Jun 22;11(6):e0158136.
doi: 10.1371/journal.pone.0158136. eCollection 2016.

Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis

Affiliations
Free PMC article
Multicenter Study

Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis

Luisa A Denkel et al. PLoS One. .
Free PMC article

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).

Design: A multi-center interrupted time series analysis.

Setting: 44 German NICUs with routine use of dual-strain probiotics on neonatal ward level.

Patients: 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.

Intervention: Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level.

Main outcome measures: 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.

Conclusion: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of VLBW infants eligible for this study.
Fig 2
Fig 2
NEC in VLBW infants (A) and in ELBW infants (B) treated in 44 neonatal departments before and after the routine medication of probiotics. Half-yearly incidences of NEC in 10,890 VLBW infants (A) and in 4,683 ELBW infants (B) treated in 44 neonatal departments before and after the routine medication of probiotics. The grey line represents the trend of NEC incidences (per 100 VLBW/ELBW infants) before and after the introduction of routine administration of probiotics.
Fig 3
Fig 3
Overall mortality in VLBW infants (A) and in ELBW infants (B) before and after the routine medication of probiotics. Half-yearly overall mortality in 10,890 VLBW infants (A) and in 4,683 ELBW infants (B) treated in 44 neonatal departments before and after the routine medication of probiotics. The grey line represents the trend of mortality (per 100 VLBW/ELBW infants) before and after the introduction of routine administration of probiotics.
Fig 4
Fig 4
Nosocomial BSI in VLBW (A) and in ELBW infants (B) before and after the routine medication of probiotics. Half-yearly incidences of nosocomial BSI in 10,890 VLBW (A) and in 4,683 ELBW infants (B) treated in 44 neonatal departments before and after the routine medication of probiotics. The grey line represents the trend of incidences of bloodstream infections (per 100 VLBW/ELBW infants) before and after the introduction of routine administration of probiotics.

Similar articles

See all similar articles

Cited by 7 articles

See all "Cited by" articles

References

    1. Polin RA, Denson S, Brady MT. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics. 2012;129(4):e1104–9. Epub 2012/03/28. 10.1542/peds.2012-0147 . - DOI - PubMed
    1. Alfaleh K, Anabrees J, Bassler D, Al-Kharfi T. Probiotics for prevention of necrotizing enterocolitis in preterm infants. The Cochrane database of systematic reviews. 2011;(3):Cd005496. Epub 2011/03/18. 10.1002/14651858.CD005496.pub3 . - DOI - PubMed
    1. Neu J, Walker WA. Necrotizing enterocolitis. The New England journal of medicine. 2011;364(3):255–64. Epub 2011/01/21. 10.1056/NEJMra1005408 ; PubMed Central PMCID: PMCPmc3628622. - DOI - PMC - PubMed
    1. Kosloske AM. Epidemiology of necrotizing enterocolitis. Acta paediatrica (Oslo, Norway: 1992) Supplement. 1994;396:2–7. Epub 1994/01/01. . - PMC - PubMed
    1. Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F. Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS. Klinische Padiatrie. 2013;225(2):75–80. 10.1055/s-0033-1334886 . - DOI - PubMed

Publication types

MeSH terms

Substances

Grant support

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Feedback