The updated Cochrane review comes with a clear recommendation - that preterm infants (defined as <37 weeks / BW <2500 g) should be given probiotics to reduce the risk of NEC.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005496.pub4/abstract

 

When reading the full review (look at the tables), my impression is that the effect among infants <1000 grams is less well documented. And I came across this editorial:

http://www.jpeds.com/article/S0022-3476%2814%2900431-4/abstract

 

What is your opinion about and/or the interpretation of the Cochrane review?

If you use probiotics - do you use it for all preterms regardless of gestational age (i.e. also for the most immature & tiny babies)?

Should I use Probiotics if my NICU population has a very low incidence of NEC ? What if using breast milk plus other non-specific measures, we could decrease NEC incidence....then is it still ethical on my part to expose my babies to probiotics ? Has the use of probiotics in these immunocompromised population been proven to be safe over a prolonged period of time ? Or is the weight of the evidence still of a short duration and awaiting more long term studies ? But do we still need long term studies?

 

Let me rephrase my concerns.....what is the minimum NEC incidence rate in my NICU at which I should consider probiotics use in the unit ?

 

(.... typed in a reflective mood ! )

No worries, as we do not use probiotics yet I don't take any comments personal

 

How low is your NEC incidence?

 

I'd estimate that our incidence is similar to the pre-probiotic era in Germany and this report discussed at neonatalresearch.org (http://neonatalresearch.org/2014/06/23/probiotics-work-in-germany-also/) seems promising, that even a low incidence can be further reduced.

If I am to use Probiotics in my unit...how do I counsel the parents ?

 

DO I need a parental consent ( like for steroid use in neonates) ?

 

If during counselling or consent process....how safe do I tell them that probiotics is ?

 

Also are all probiotics available in the market the same?...do theyhave the same organisms ..the same strain...the same concentration?....can I generalize the findings of a study done with probiotic Brand A to probiotic Brand B ? Or should I stick to Brand A...the one that was used in the RCT ?

 

 

(hey...nothing personal.....just trying to give constructive criticism... )

(In the past one year we had one surgical NEC in 95 babies with birth weight less than 1.5kg)

In the maternal colostrum there are 400 types of friendly bacterias. Collecting colostrum and giving it sublingual to extreme preterm infants is the best way to "give" probiotids.

The commercial probiotics are not including the needed probiotics and prebiotics for newborns.

The expected outcome of the Microbiome project and the human milk gut microbiome and immunity project is to leads us to a new area of selected highly effective probiotics for newborns

Some input from Keith Barrington and his blog www.neonatalresearch.org (a blog I advice all to follow!)

 

http://neonatalresearch.org/2014/09/23/the-time-for-a-confirmative-necrotizing-enterocolitis-probiotics-prevention-trial-in-the-extremely-low-birth-weight-infant-in-north-america-is-well-past/

http://neonatalresearch.org/2014/09/24/probiotics-so-what-about-those-elbw-babies/

What other chemicals or contaminants are in Probiotics? How do you know? How do you know what is on the label is really in the capsules you giving to the premie? There is no regulation in the US. There must be strict monitoring in the rest of the world for Cochrane's recommendation.

Can we are assume that there is no or little downside to Probiotics. I don't think we can answer that question until we can be assured we know what is in capsule, bottle, batch.

Danie lubin [emoji106] [emoji106] [emoji106]

I liked the idea of colostrum sublingual

Will be easy to implement

@Danielubin [emoji106]

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