Probiotics’ Effect On Gastrointestinal Function Of Very Low Birth Weight Preterm Infants

Objective To evaluate probiotics’ effect on gastrointestinal function of very low birth weight preterm infants, mainly on morbidities and mortalities of neonatal necrotizing entero colitis, feeding intolerance and parenteral nutrition associated cholestasis. Additionally, the safety of probiotics was assessed.Method The clinical data of100VLBW preterm infants admitted to our department from January2010to November2011were retrospectively studied.45cases (27male vs18female), gestational age30.1±1.7weeks, birth weight1260.13±194.82g, were in probiotic group;55cases (25male vs30female), gestational age31.2±2.2weeks, birth weight1278.55±146.88g, were in control group. Comparisons were made between the groups on the follo wings:demographic data, incidence and severity of NEC, mortalities (NEC related death and non NEC related death), morbidities of diseases (sepsis, feeding intolerance and PNAC), time to recover the birth weight and growth velocity. The side effects of probiotics were recorded.Result Gestational age in probiotic group was significantly low-er than that in control group (30.1±1.7wks vs31.2±2.2wks;t=-2.804, P=0.006). Cases with complications(apnea, respiratory failure and NRDS), with longer duration of hospitalization, parental nutrition, PI CC, and nasal feeding, were remarkably more in probiotic group than that in control group[(28/45vs22/55;χ2=4.889, P=0.027),(46.47±22.43d vs34.65±21.84d;t=2.658, P=0.009),(35.73±16.78d vs26.40±18.56d; t=2.611, P=0.010),(19.36±23.64d vs5.71±11.52d; Z=-3.291, P=0.001),(24.79±17.79d vs11.62±11.76d; Z=-3.784, P=0.000)]. The uneven distribution of the perinatal and clinical items related to GI function had influenced the outcome of this trial.The incidence of NEC in probiotic group (6.7%) was significantly lower than that in control group (21.8%), with relative risk0.256(95%CI:0.067～0.972;χ2=4.456,P=0.035). All the3cases with serious NEC (Bell’s III grade) were in the control group, but there was no statistically difference between the groups (0/45vs3/55;χ2=1.003, P=0.317).2VLBW premature infants died in the probiotic group (one related to NEC), whereas5cases died in the control group (3cases related to NEC). No significant difference was found between the groups on total mortalities or NEC related death [(2/45vs5/55;χ2=0.262,P=0.609),(1/45vs3/55;χ2=0.912, P=0.634)]. There was no significant difference between the two groups on incidence of sepsis (6/45vs6/55;χ2=0.138, P=0.711), feeding intolerance (24/45vs29/55;χ2=0.004,P=0.952) and PNAC (9/44vs16/52;χ2=1.317, P=0.251). Comparisons on time to recover the birth weight and growth velocity turned out as followings:(7.98±6.41d vs9.11±5.88d;t=-0.919,P=0.361),(10.82±5.93g/Kg/d vs8.98±5.13g/Kg/d;t=1.665,P=0.099). No probiotic related sepsis, meningitis, diarrhea or rashes were recorded.Conclusion Oral probiotics (combination of BB-12and LGG) c ould significantly reduce the incidence of NEC in very low birth wei ght preterm infants, and inclined to alleviate both the severity of the disease and mortalities. The results indicated that probiotics had a sl ight impact, not significant, on sepsis and PNAC. They couldn’t prev ent feeding intolerance, nor could they accelerate growth velocity or shorten the time to recover the birth weight remarkably. The defect o f our research was that all the cases were retrospectively studied, lea ding to the uneven distribution of perinatal and clinical items associat ed with GI function between the groups, which affected the final out come of this trial. Therefore, prospective, randomized, controlled trials were needed to elucidate probiotics’ effect on GI function of VLBW premature infants. There were no records of probiotic related sepsis, meningitis, diarrhea or rashes. So, it was relatively safe to take in BB-12and LGG for VLBW preterm infants.