Is there any good quality evidence around probiotics and reduction or increase in infections in neonates?

Dear Praveen

here is a table summarising recent studies about this issue.

I hope it is of value.

table2.docx

Thanks @ialhifzi could you add the ref to the list you shared above?

@praveen the second ref i the list above is the meta-analysis by Wang et al https://pubmed.ncbi.nlm.nih.gov/37782505/

Taken together, there is reduced risks generally, but strain specific effects are still an area for research

Dear Prof.Johanson

My pleasure, I will attach a referece list.

It is part of work I am preparing for publication.

Regards

Ibrahim Alhifzi. consultant Neonatologist

President of Saudi Neonatology Society. ref.docx

ref.docx

A recently published meta-analysis* assessed the overall risk-benefit profile of probiotic use in the preterm infants. The analysis included 77 articles (40 RCTs, 23 cohorts, and 14 case reports), and the pooled estimates of incidence were calculated using random-effects models. Results indicated that:

• Among the 20,323 infants exposed to probiotics, there were 8 cases (<0.04%) of "probiotic sepsis”, mainly in ELBW infants and those at risk for bacterial translocation.

• Risk-benefit modeling revealed that for each case of probiotic-associated sepsis, an estimated 92 additional cases of clinical sepsis, 62 additional cases of NEC, and 42 additional deaths would be expected in the population NOT receiving probiotics.

Given the overwhelming benefit-to-risk ratio, this study supports the use of probiotics in preterm infants. Risk stratification may be appropriate to exclude the most vulnerable subgroups, particularly those at highest risk for bacterial translocation or with severely compromised gut integrity. As diagnostic tools and monitoring capabilities improve, the already rare incidence of probiotic-associated sepsis could be reduced even further. Perhaps it is time to reframe the discussion and move beyond the clinical hesitancy around the probiotic use. After all, is it justifiable to risk 92 additional cases of sepsis, 62 cases of NEC, and 42 deaths to prevent a single case of probiotic-associated sepsis? The data speak clearly…now it's your turn to decide.

* Feldman K, Noel-MacDonnell JR, Pappas LB, Romald JH, Olson SL, Oschman A, Cuna AC, Sampath V. Incidence of probiotic sepsis and morbidity risk in premature infants: a meta-analysis. Pediatr Res. 2025 May 13. doi: 10.1038/s41390-025-04072-3. Epub ahead of print. PMID: 40360772.

PubMed

Incidence of probiotic sepsis and morbidity risk in prema...

This study quantifies the risk of probiotic sepsis in preterm infants utilizing a meta-analysis. In over 20,000 exposed infants across 40 randomized trials and 23 observational studies, 8 cases of...