Journal Article

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

Wieg, Christian, Siller, Bastian, Spiegler, Juliane, Stein, Anja, Faust, Kirstin, Zemlin, Michael, Eyvazzadeh, Leila, Marißen, Janina, Roll, Claudia, Pirr, Sabine, Herting, Egbert, Tröger, Birte, Göpel, Wolfgang, Humberg, Alexander, Pagel, Julia, Rupp, Jan, Hanke, Kathrin, Härtel, Christoph, Körner, Thorsten, Derouet, Christoph, Brenner, Kim, Viemann, Dorothee, Fortmann, Ingmar, Stavropoulou, Dimitra, Henneke, Philipp

2020

Overview

Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth. Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models. Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82–4.35; p < 0.001) but not in the F group (effect size B = −0.06; 95% CI: −3.05–0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59–0.79; p < 0.001). Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

• Publisher: MDPI AG,MDPI
• Subject: Bifidobacterium longum subsp. infantis / Bifidobacterium longum subspecies infantis / Birth weight / Blood / breast milk / Confidence intervals / Dietary Supplements / Enteral nutrition / enterocolitis / Enterocolitis, Necrotizing - prevention & control / Female / Gender / Gestational Age / Hospitals / Humans / incidence / Infant Formula / infant formulas / Infant Nutritional Physiological Phenomena / Infant, Newborn / Infant, Premature - growth & development / Infant, Premature - physiology / infants / Intensive care / Laboratories / Lactobacillus acidophilus / Lung diseases / Male / Milk, Human / Multiple births / Newborn babies / nutrients / Nutrition / observational studies / Obstetrics / Pre-Exposure Prophylaxis / pregnancy / premature birth / Probiotics / Probiotics - administration & dosage / regression analysis / Sepsis / Sepsis - prevention & control / Velocity / weight gain