- 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.
- Advice from European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) based on recent network meta-analysis.
- Reported in this population:
- Bacteremia with probiotic strains.
- Gastrointestinal mucormycosis from contaminated probiotics.
- Commercial probiotics often lack quality controls.
- 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.