Volume 15, Issue 4, April 2015, Pages 378–379
Correspondence
Probiotics to prevent early-life infection
- Refers To
Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
- The Lancet Infectious Diseases, Volume 14, Issue 8, August 2014, Pages 731-741
Anna Seale and colleagues1
reported estimates of possible severe bacterial infection in neonates
in resource-limited settings. Worldwide about 15 million infants are
born preterm each year and about 1 million of them die in infancy.2
Additionally, roughly 18 million infants are born with low birthweight,
predominantly in low-income and middle-income countries. This
population has a high burden of morbidity and mortality associated with
invasive infections in the neonatal period and early infancy.3
Despite partial success in improvement of childhood mortality as part
of WHO millenium goals, neonatal and early infant mortality has remained
mostly unchanged since 2000.3
A
review by Alfaleh and colleagues in 2014 (24 randomised trials, n=5000)
supports that enteral probiotic supplementation significantly reduces
necrotising enterocolitis (relative risk [RR] 0·43, 95% CI 0·33–0·56)
and all-cause mortality (RR 0·65, 95% CI 0·52–0·81) in very low
birthweight infants (weighing <1500 g), with an excellent saftey
profile and without adverse effects.4
Most
of these trials (22 of 24) were done in high-income countries and in
this setting probiotics had no significant effect on late-onset sepsis, a
common complication of preterm birth, affecting up to 50% of the most
immature infants (infants born before 28 weeks gestation; RR 0·91, 95%
CI 0·80–1·03).4
By contrast, trials of probiotics done in resource-poor and emerging
settings show a significantly reduced incidence of bacterial and fungal
late-onset sepsis in very low birthweight infants.5, 6 and 7
The benefits of probiotics in resource-poor settings are supported by a
trial in a community setting in India in 2013 (n=4556), in which low
birthweight infants (weighing >2000 g) were given Lactobacillus plantarum
and the prebiotic fructo-oligosaccharide, resulting in a significant
reduction in serious infections (sepsis, pneumonia, and diarrhoea)
during the first 60 days of life (personal communication). 8
The reported reductions in late-onset sepsis caused by probiotic
supplementation are probably affected by the gestational age and
birthweight of the infants, the local pattern of invasive pathogens, the
pathogen's antibiotic susceptibilities, and the type of probiotic
strain or strains used.
In
view of the global burden of preterm and very low birthweight infants
with invasive infection and the increasing numbers of
multidrug-resistant microorganisms, probiotics have much potential in
resource-poor settings as a simple, safe, and affordable public health
intervention. Additional research is essential to address the present
gaps in knowledge on probiotics for treating preterm and low birthweight
infants, especially in the context of resource poor settings. In view
of the cost associated with the import, storage, and distribution of
proven probiotic strains, future randomised controlled trials could
compare the efficacy and safety of proven strains with that of local
strains. Such trials could also assess whether the benefits of
single-strain products might be further optimised by their combination
with additional strains. Clinical trials in other resource-poor settings
are essential to confirm and expand present findings by Panigrahi and
colleagues8 of broadly and significantly reduced mortality due to serious infections in infants given prebiotics.
We declare no competing interests.
References
- 1
- Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
- Lancet Infect Dis, 14 (2014), pp. 731–741
- | | |
- 2
- Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis
- Lancet, 382 (2013), pp. 417–425
- | | |
- 3
- Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000
- Lancet, 379 (2012), pp. 2151–2161
- | | |
- 4
- Probiotics for prevention of necrotizing enterocolitis in preterm infants
- Cochrane Database Syst Rev, 4 (2014) CD005496.
- 5
- Role of enteric supplementation of probiotics on late-onset sepsis by Candida species in preterm low birth weight neonates: a randomized, double blind, placebo-controlled trial
- N Am J Med Sci, 6 (2014), pp. 50–57
- |
- 6
- Lactobacillus reuteri for the prevention of necrotising enterocolitis in very low birthweight infants: a randomised controlled trial
- Arch Dis Child Fetal Neonatal Ed, 99 (2014), pp. F110–F115
- | |
- 7
- Prophylactic probiotics for prevention of necrotizing enterocolitis in very low birth weight newborns
- J Trop Pediatr, 55 (2009), pp. 128–131
- |
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