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Review: probiotics prevented necrotising enterocolitis and reduced mortality in preterm neonates

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Question

In preterm neonates [patients] do probiotics [intervention] reduce the risk of necrotising enterocolitis (NEC) and death [outcome]?

Review scope

Trials were selected which compared probiotics to control in neonates of <34 weeks' gestation and birth weight of <1500 g. Outcomes included prevention of stage II NEC or higher, all cause mortality, sepsis and time to reach full feeds (TFF).

Review methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, proceedings of the Pediatric Academic Society meetings and gastroenterology conferences and reference lists were searched for randomised controlled trials (RCTs). No language restriction was applied. The quality of studies was assessed using the Jadad score. Eleven RCTs were included. Trial sequential analysis (TSA) was performed to evaluate whether the findings of the meta-analysis were conclusive.

Main results

The 11 studies included 2176 neonates (table 1). All had a Jadad score ≥3. A funnel plot did not suggest publication bias. Meta-analysis results indicate benefit for probiotics in preventing NEC, thus reducing mortality. Only five trials had NEC or death and NEC as primary end points. Sensitivity analysis of these five studies showed significant benefit for probiotics. No significant heterogeneity was found. There was no significant difference in sepsis …

Correspondence to Keith J Barrington, Centre Hospitalier Universitaire Sainte Justine, 3175 Cote Ste Catherine, Montreal H3T 1C5, Canada; keith.barrington{at}umontreal.ca

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