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

• Published in: PloS one 2016-06, Vol.11 (6), p.e0158136-e0158136
• Main Authors: Denkel, Luisa A, Schwab, Frank, Garten, Lars, Geffers, Christine, Gastmeier, Petra, Piening, Brar
• Format: Article
• Language: English
• Subjects: Analysis; Bifidobacterium; Bifidobacterium infantis; Biology and Life Sciences; Birth; Birth weight; Births; Breastfeeding & lactation; Causes of; Cross Infection - drug therapy; Enterocolitis; Enterocolitis, Necrotizing - drug therapy; Environmental health; Female; Gastrointestinal diseases; Health aspects; Hospitals; Humans; Hygiene; Infant, Extremely Low Birth Weight - physiology; Infant, Newborn; Infant, Premature - physiology; Infant, Very Low Birth Weight - physiology; Infants; Intensive care units; Interrupted Time Series Analysis; Lactobacillus acidophilus; Low birth weight; Male; Medicine; Medicine and Health Sciences; Mortality; Necrosis; Necrotizing enterocolitis; Neonates; Newborn babies; Nosocomial infection; Nosocomial infections; Pediatrics; People and Places; Premature babies; Premature infants; Probiotics; Probiotics - therapeutic use; Prophylaxis; Proportional Hazards Models; Protective Agents - pharmacology; Protective Agents - therapeutic use; Sentinel surveillance; Studies; Subgroups; Surgery; Surveillance; Systematic review; Time series
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158136

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). A multi-center interrupted time series analysis. 44 German NICUs with routine use of dual-strain probiotics on neonatal ward level. 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. Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level. Incidences of NEC, overall mortality, mortality following NEC and nosocomial BSI. 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. 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.