Probiotics for Preterm Infants - The Western Australian Experience

Sanjay PATOLOE

Centre for Neonatal Research and Education, University of Western Australia, Perth

Survival of preterm, especially extremely preterm (<28 weeks) infants without neurodevelopmental impairment is the ultimate goal in neonatal intensive care. Probiotic supplementation is an important step towards this direction.

Systematic reviews of randomized controlled trials (RCTs) indicate that probiotics significantly reduce the risk of ≥ Stage II necrotising enterocolitis (NEC), all-cause mortality, late onset sepsis (LOS), and feeding intolerance in preterm LBW (gestation <37 weeks; BW <2500 g) infants in high as well as low and middle income countries. Evidence from over 50 RCTs (N=5000) and 14 non-RCTs (N=5000) suggests that benefits of probiotics outweigh the risks associated with the intervention. A systematic review of observational studies has confirmed the benefits of probiotic supplementation in preterm infants.

Cross-contamination (~45%) of the control arm participants is a significant issue in estimating the effects of probiotic supplementation in a RCT reliably. Considering the limited data from cluster RCTs in this field, data from single centre large observational studies (i.e. ‘real life’ situation) of routine probiotic supplementation in preterm very low birth weight (VLBW) infants are important in the context of cross-contamination.

The tertiary level neonatal intensive care unit, at King Edward Memorial Hospital for Women, Perth, is the sole regional neonatal referral centre for the state of Western Australia. It is one of the largest and busiest such units in the Southern hemisphere, and admits 300-350 very preterm infants (gestation <32 weeks) including ~120 extremely preterm infants (gestation <28 weeks) per year. The results of an observational study (N=1755) comparing outcomes ‘before’ (Epoch I: December 2008-November 2010; n=835) vs. ‘after’ (Epoch 2: June 2012 to May 2014, n=920) implementation of routine probiotic (B. breve M-16 V) supplementation for preterm VLBW infants are presented. Current controversies and the global scenario about the use of probiotics in preterm VLBW infants are reviewed briefly.