The Administration of Probiotics in Extremely Low-Birth-Weight Infants and the Incidence of Necrotizing Enterocolitis and Mortality: A Systematic Review

Encouraging findings were previously demonstrated in a previous meta-analysis that analyzed the results of randomized controlled trials (RCTs) that investigated the potential favorable effects of probiotics administration in preterm infants to prevent necrotizing enterocolitis (NEC) and feeding intolerance. This evidence has only been linked to low birth-weight infants (<1000 g), while evidence regarding the impact of administration of these modalities for Extremely Low-Birth-Weight Infants (ELBW) infants is still controversial among the different studies in the literature. A systematic review was conducted to retrieve all the relevant randomized controlled trials in the literature that investigated the impact of probiotics administration on the different outcomes in ELBW infants, including the incidence of mortality and NEC. A thorough search was then conducted through the different databases to find the relevant articles.A total of 11 RCTs were included in the present systematic review. All articles were published between 2007 and 2021, with a total of 3225 ELBW infants were included in both the intervention and control groups across the different included trials. Our results indicate that the administration of these modalities does not have a significant impact on these outcomes. However, it has been reported that they enhance the growth rate, especially head growth circumference, which has been reported to be superior to the placebo effect. Further investigations for ELBW should be encouraged to furtherly validate these modalities, although no adverse events have been reported for their administration among trials in the current systematic review.

Automated summary

The potential benefits of probiotics in preventing necrotizing enterocolitis and feeding intolerance in preterm infants are mainly seen in low birth-weight infants, while their impact on extremely low-birth-weight infants remains controversial. The systematic review found no significant impact of probiotics administration on outcomes such as mortality and NEC in ELBW infants, but did show improvements in growth rates, particularly head circumference growth. Further research is encouraged to verify these findings for ELBW infants.