SAN DIEGO, CA—Adding routine probiotic prophylaxis in neonatal intensive care units (NICUs) is protective against necrotizing enterocolitis and bloodstream infections among extremely low birth weight (ELBW) infants, and improves their survival rates following necrotizing enterocolitis, according to authors of a multicenter quasi-experimental study in Germany.

Preterm infants with extremely low birth weight (<1000g) are at an increased risk for developing necrotizing enterocolitis. Studies have shown that probiotics can reduce the risk of necrotizing enterocolitis in preterm infants but many NICUs do not utilize probiotic prophylaxis due to safety concerns.

Luisa A. Denkel, PhD, from the Charite University Medical Center Berlin, in Berlin, Germany, and colleagues conducted a retrospective analysis to determine the effect of probiotics on necrotizing enterocolitis and bloodstream infections in ELBW infants’ pre- and post- implementation at 229 German neonatal intensive care units.

The coauthors used data from NEO-KISS, the German surveillance system for nosocomial infections in preterm infants to analyze all 44 NICUs that utilized probiotics as prophylaxis for ELBW infants and patients admitted between 36 months before and 36 months after the start of probiotic exposure. They retrospectively compared data before and after probiotics were adopted at each NICU, for a total of 4,683 ELBW infants, among whom there were a total of 215 (4.6%) cases of necrotizing enterocolitis and 1133 (24.2%) cases of bloodstream infection.

All 44 NICUs in the study used probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. However, protocols for probiotics administration varied between institutions, Dr. Denkel noted.

Adoption of probiotics for ELBW infants was associated with a >50% reduction in the risk of necrotizing enterocolitis (hazard ratio [HR] 0.48; 95% CI: 0.36, 0.64; P<0.001) and a 15% reduction in the risk of bloodstream infections (HR 0.83; 95% CI: 0.74, 0.94; P=0.002), Dr. Denkel reported.

Overall ELBW infant mortality was lower during the probiotics time period than the pre-probiotics time period at these 44 NICUs (HR 0.59; 95% CI: 0.41, 0.84; P=0.036).  Among infants with necrotizing enterocolitis (n=215), mortality was 40% lower after NICUs adopted probiotics than during the pre-probiotic time period.

“It is advisable to add routine probiotic prophylaxis to neonatal wards as soon as possible,” concluded Dr. Denkel.