Use of Probiotics in the NICU - Part 2
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Use of Probiotics in the NICU - Part 2

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Use of Probiotics in the NICU - Part 2

Use of Probiotics in the NICU - Part 2

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Use of Probiotics in the NICU - Part 2 Use of Probiotics in the NICU - Part 2 Presentation Transcript

  • Use of Probiotics in the NICU
    • Part 2
  • Immunonutrition
    • Probiotics for prevention of NEC
      • The primary objective
        • To compare the effectiveness and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe (stage II or more) NEC and/or sepsis in preterm infants
      • The secondary objective
        • To conduct a subgroup analysis to investigate the effect of probiotics in extreme low birth weight infants (infants with birth weight <1000 g)
    Immunonutrition
    • The Available Literature
      • 191 potentially relevant citations
      • 179 citations excluded because irrelevant
      • 12 RCTs were identified as potentially relevant
      • 10 studies comparing probiotics to control
      • 9 RCTs included in the meta-analysis
      • 2 RCTs were excluded since no clinical outcomes were reported
      • 1 RCT was deferred till further assessment
    Immunonutrition
    • Prebiotics - Clinical Evidence
      • 1425 infants were randomized
      • Highly variable with regard to
        • Enrollment criteria
        • Baseline risk of NEC in the control groups
        • Timing
        • Dose
        • Formulation of the probiotics
        • Feeding regimens
    Immunonutrition
  • Immunonutritio n
    • Probiotics – NEC Prevention
  • Immunonutrition
    • Probiotics – Mortality
  • Immunonutrition
    • Probiotics – Days to Full Feeds
    • Probiotics – Safety Profile
      • Risk of translocation
        • Several reported cases with Lactobacillis
        • No reported cases with Bifidbacterum
      • Several reports of probiotic species sepsis have been reported in the literature
        • Mostly in immunocompromised hosts
        • None of the included studies reported sepsis caused by probiotics organism
      • Several cases of sepsis in short gut patients
    Immunonutrition
  • Immunonutrition
    • Questions and Probiotics in the NICU
      • Have we also looked at ↓ antibiotic usage?
      • Can we initiate practices that facilitate infant colonization with maternal flora?
        • C/S without ROM
        • Early skin-to-skin opportunities
      • When using probiotics in the NICU?
        • Is there evidence of best preparations?
        • Which preparation is best for neonatal population?
        • Are the probiotics of human origin?
        • Where did we get them?
        • How do we determine dosage?
  • Immunonutrition
    • Dosing Prebiotics
      • Considered supplements
      • Not regulated by the FDA
      • Unclear, non-standardized
      • 3.5 X 10 7 to 3.5 X 10 9 CFU
      • Duh!
    • Prebiotics
      • Non-digestible food ingredients
      • Fructo-oligosaccharides (FOS)
      • Galacto-oligosaccharides (GOS)
    • Positively affect the endogenous flora
    • Stimulate the growth of one or a limited number of bacterial species
      • FOS - Bifidobacteria
      • Lactulose - Lactobacilli
    Immunonutrition
    • Synbiotics
      • A probiotic organism + its prebiotic food
      • Providing both the organism and substrate at the time of ingestion may offer improved chance of the prebiotics survival in GI tract
    • Risk of adding prebiotics
      • Recent reports of thickening agents being linked to NEC
      • There are similar substances in these agents and prebiotics
    Immunonutrition