Researchers at Griffith University used advanced big data analysis to identify specific probiotic supplements, and ultimately assessed 45 randomised controlled trials with 12,320 participants from 19 different locations including the US, Asia, Europe, Africa and Australia.
The included RCTs estimated the effect of six different probiotic strains (Bifidobacterium, Lactobacillus, Enterococcus, Saccharomyces, Streptococcus, and Bacillus), and their combinations on the health parameters of premature infants.
They found Bifidobacterium plus prebiotic supplementation was the optimal intervention in reducing infant mortality, while Lactobacillus plus prebiotic supplementation was the optimal intervention in reducing necrotising enterocolitis (NEC).
In relation to the role of the prebiotic, the researchers wrote: “The prebiotic interacts with the probiotic, leading to a synergistic effect to boost the antibacterial defence of infants’ immature intestinal tract barrier. In addition, prebiotic supplements have been proved to accelerate intestinal maturation in preterm infants.”
The duration of treatment varied from two to nine weeks or covered the infant’s hospitalisation.
Baseline parameters including gestational age, birth weight, sex and sample size were similar across the study.
Common problem
“Despite improvements in gestation management and healthcare, pre-term birth remains a common and serious pregnancy problem,” says lead researcher Associate Professor Jing Sun.
“The prevalence of pre-term birth ranges from 5% to 18% across 184 countries and 15 million infants are born pre-term globally.
“As intestinal muscosa is a natural barrier for migration of bacteria, immature immune system and gastrointestinal tracts are at risk of complications and are a leading cause of neonatal death.”
Associate Professor Sun said recent studies suggest the composition of infants’ gut microbiota was affected by birth weight and gestational age.
“Altered gut microbiota has been proven to put infants at high risk of developing NEC and sepsis and they often present at a late stage.
“It is evident that early probiotic supplementation may benefit premature infants by improving their gastrointestinal tolerance again potential pathogens and regulating the altered gut microbiota to that of a healthy infant.
“We hope this study will contribute to a better understanding of combined probiotics and its effectiveness in reducing future disease burden caused by preterm birth.”
The paper noted: “Further, our results demonstrated that combined use of probiotics may have better efficacy in premature infants than the single strain.
“The combined use of probiotics ranks higher than single use both in each parameter and in general.
“This is consistent with Guthmann et al., who reported that two or more probiotic strains or a combination of Bifidobacterium and Lactobacillus achieves the best results in preterm infants.
“Thus, in further design of trials and clinical use, combination of probiotics and their synergistic effect should be taken into account.”
Source: Pediatrics
DOI: https://doi.org/10.1542/peds.2020-0706
Effects of Probiotics in Preterm Infants: A Network Meta-Analysis
Authors: Jing Sun, et al.
