Probiotics for the prevention of surgical necrotising enterocolitis: systematic review and meta-analysis

Abstract

Aim of the study

Probiotic administration to preterm infants has the potential to prevent necrotising enterocolitis (NEC). Data from randomised controlled trials (RCT) are conflicting but meta-analyses seem to support this intervention. To date, these analyses have not focused on surgical NEC. We aimed to determine the effect of probiotic administration to preterm infants on prevention of surgical NEC.

Methods

A systematic review of RCTs of probiotic administration to preterm infants was performed. Studies were included if RCT outcomes included any of (1) Bell’s stage 3 NEC; (2) surgery for NEC; and (3) deaths attributable to NEC. Article selection and data extraction were performed independently by two authors; conflicts were adjudicated by a third author. Data were meta-analysed using Review Manager V.5.3. A random effects model was decided on a priori because of the heterogeneity of study design; data are risk ratio (RR) with 95% CI.

Main results

Thirty-five RCTs reported NEC as an outcome. Seventeen reported surgical NEC; all RCTs were included. A variety of probiotic products was administered across studies. Description of surgical NEC in most studies was poor. Only 6/16 specifically reported incidence of surgery for NEC, 12/17 Bell’s stage 3 and 13/17 NEC-associated mortality. Although there was a trend towards probiotic administration reducing stage 3 NEC, this was not significant (RR 0.74 (0.52–1.05), p=0.09). There was no effect of probiotics on the RR of surgery for NEC (RR 0.84 (0.56–1.25), p=0.38). Probiotics did, however, reduce the risk of NEC-associated mortality (RR 0.56 (0.34–0.93), p=0.03).

Conclusion

Despite 35 RCTs on probiotic prevention of NEC, evidence for prevention of surgical NEC is not strong, partly due to poor reporting. In studies included in this meta-analysis, probiotic administration was associated with a reduction in NEC-related mortality.

Journal

Journal ID (nlm-ta): BMJ Paediatr Open

Journal ID (iso-abbrev): BMJ Paediatr Open

Journal ID (hwp): bmjpo

Journal ID (publisher-id): bmjpo

Title: BMJ Paediatrics Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2399-9772

Publication date Collection: 2017

Publication date (Electronic): 1 November 2017

Volume: 1

Issue: 1

Affiliations

[1 ]UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust , London, UK

[2 ]departmentDepartment of Paediatric Surgery and Urology, Faculty of Medicine , University of Southampton , Southampton, UK

[3 ]departmentLondon School of Medicine and Dentistry , Homerton University Hospital and Barts , London, UK

Author notes

[Correspondence to ] Dr Simon Eaton; s.eaton@ 123456ucl.ac.uk

Article

Publisher ID: bmjpo-2017-000066

DOI: 10.1136/bmjpo-2017-000066

PMC ID: 5862194

Copyright statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Product

Categories

Subject: Original Article

Subject: 1506