Probiotics for preterm infants: ESPGHAN releases position paper

  • van den Akker CHP & al.
  • J Pediatr Gastroenterol Nutr
  • 7 Feb 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Providers proposing to treat preterm infants with probiotics should work with local microbiologists, be vigilant about product quality, and avoid certain strains.

Why this matters

  • Prior trials have suggested benefit with regard to necrotizing enterocolitis (NEC), sepsis, mortality.
  • Many questions surround optimal strains, dosages, durations.

Description

  • Advice from European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) based on recent network meta-analysis.

Key points

  • Reported in this population:
    • Bacteremia with probiotic strains.
    • Gastrointestinal mucormycosis from contaminated probiotics.
  • Commercial probiotics often lack quality controls.
  • Recommendations:
    • Inform microbiologists; confirm ability to detect bacteremia with therapeutic strains.
    • Avoid strains that produce D-lactate or that contain plasmids with antibiotic resistance genes.
    • Look for Good Manufacturing Practice certification, formal viability report.
    • Inform parents of risks, benefits.
  • To reduce NEC, authors recommend (conditional; low certainty of evidence):
    • Lactobacillus rhamnosus GG ATCC 53103; dose, 1-6×109 CFU.
    • Combination of Bifidobacterium infantis Bb-02, B lactis Bb-12, and Streptococcus thermophilus TH-4; dose, 3.0-3.5×108 CFU/strain.
  • No recommendation regarding:
    • L reuteri DSM 17938.
    • B bifidum NCDO 1453 (B longum) plus L acidophilus NCDO 1748.
  • Not recommended:
    • B breve BBG-001.
    • Saccharomyces boulardii.
  • Base strain, dosing on well-conducted trials.
  • Choose proven strain(s) over mix of genera.
  • Much more well-conducted research is needed.