Neutral and acidic oligosaccharides in preterm infants: a randomized, double-blind, placebo-controlled trial

Background: Serious infectious morbidity is high in preterm infants. Enteral supplementation of prebiotics may reduce the incidence of serious infections, especially infections related to the gastrointestinal tract. Objective: The objective was to determine the effect of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides ((SC)GOS/LCFOS) and acidic oligosaccharides (AOS) on serious infectious morbidity in preterm infants. Design: In a randomized controlled trial, preterm infants (gestational age < 32 wk and/or birth weight < 1500 g) received enteral supplementation of 80% (SC)GOS/LCFOS and 20% AOS (1.5 g . kg(-1) . d(-1)) or placebo (maltodextrin) between days 3 and 30 of life. Serious infectious morbidity was defined as a culture positive for sepsis, meningitis, pyelonephritis, or pneumonia. The analysis was performed by intention-to-treat and per-protocol, defined as >= 50% supplementation dose during the study period. Results: In total, 113 preterm infants were included. Baseline and nutritional characteristics were not different between groups. In the intention-to-treat analysis, the incidence of >= 1 serious infection, >= 1 serious endogenous infection, or >= 2 serious infectious episodes was not significantly different in the (SC)GOS/LCFOS/AOS-supplemented and placebo groups. In the per-protocol analysis, there was a trend toward a lower incidence of >= 1 serious endogenous infection and >= 2 serious infectious episodes in the (SC)GOS/LCFOS/AOS-supplemented group than in the placebo group (P = 0.09 and P = 0.07, respectively). Conclusions: Enteral supplementation of (SC)GOS/LCFOS/AOS does not significantly reduce the risk of serious infectious morbidity in preterm infants. However, there was a trend toward a lower incidence of serious infectious morbidity, especially for infections with endogenous bacteria. This finding suggests a possible beneficial effect that should be evaluated in a larger study. This trial was registered at isrctn. org as ISRCTN16211826. Am J Clin Nutr 2010;91:679-86.