Which is the best probiotic treatment strategy to prevent the necrotizing enterocolitis in premature infants: A network meta-analysis revealing the efficacy and safety

Le-Wee Bi, Bei-Lei Yan, Qian-Yu Yang, Miao-Miao Li, Hua-Lei Cui, Le-Wee Bi, Bei-Lei Yan, Qian-Yu Yang, Miao-Miao Li, Hua-Lei Cui

Abstract

Background: Previous studies have neglected to report the specific action of different probiotic genera in preterm infants. To evaluate the efficacy and safety of specific probiotic genera, we performed a network meta-analysis (NMA) to identify the best prevention strategy for necrotizing enterocolitis in preterm infants.

Methods: MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials had been searched for randomized control trials reporting the probiotics strategy for premature infants.

Results: We identified 34 eligible studies of 9161 participants. The intervention in the observation group was to add probiotics for feeding: Lactobacilli in 6 studies; Bifidobacterium in 8 studies; Bacillus in 1 study; Saccharomyces in 4 studies and probiotic mixture in 15 studies. This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants. A probiotic mixture showed effectiveness in reducing mortality in preterm infants.

Conclusion: The recent literature has reported a total of 5 probiotic strategies, including Bacillus, Bifidobacterium, Lactobacillus, Saccharomyces, and probiotic mixture. Our thorough review and NMA provided a piece of available evidence to choose optimal probiotics prophylactic strategy for premature infants. The results indicated that probiotic mixture and Bifidobacterium showed a stronger advantage to use in preterm infants; the other probiotic genera failed to show an obvious effect to reduce the incidence of NEC, sepsis and all-cause death. More trials need to be performed to determine the optimal probiotic treatment strategy to prevent preterm related complications.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart showing the search strategy and search results. The relevant number of papers at each point is given.
Figure 2
Figure 2
Network plot of RCTs comparing different probiotic treatment strategies for preterm-related complications. The width of the lines is proportional to the number of trials comparing each pair of treatments with numbers on the lines illustrating the exact number. The size of the circles represents the cumulative number of patients for each intervention. A: Placebo; B: Probiotic mixture; C: Bifidobacterium; D: Saccharomyces; E: Lactobacillus; F: Bacillus.
Figure 3
Figure 3
Risk of bias summary and graph showing authors judgement about each risk of bias item for the randomized trial.
Figure 4
Figure 4
Comparison funnel plots for publication bias analysis.

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