Benefits of Probiotics in Preventing Necrotizing Enterocolitis in HIV-exposed Premature Very Low Birth Weight Infants

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Effect of Probiotic Supplements on Necrotizing Enterocolitis in HIV-exposed Infants: A Randomised, Controlled Trial

A double-blind, randomised, placebo-controlled clinical trial published in the Journal of Tropical Pediatrics evaluated the effect of probiotic supplementation on the incidence of necrotizing enterocolitis (NEC) in human immunodeficiency virus (HIV)-exposed and HIV-unexposed premature, very low birth weight (VLBW) infants.

The study included 184 premature infants (<34 weeks’ gestation) with VLBW (<1,250 g). Out of these infants, 74 were HIV-exposed and 110 were HIV-unexposed. Both HIV-exposed and HIV-unexposed infants were further randomised to the intervention (37 and 54 infants, respectively) or control group (37 and 56 infants, respectively). Infants in the intervention group received Lactobacillus rhamnosus GG and Bifidobacterium infantis (each 0.35×109 colony-forming units), while those in the control group received medium-chain triglyceride oil. Probiotics and placebo were mixed in mothers’ breast milk or donor breast milk and a daily dose of five drops were administered to the infants orally or via an orogastric tube for four weeks. The incidence and severity of NEC in premature infants, following probiotic supplementation, were the primary outcomes evaluated.

There was no significant difference in the incidence of death (4 versus 7) or all stages of NEC (4 versus 5) between HIV-exposed and HIV-unexposed groups. However, in the intervention group, there was a significantly lower incidence of all stages of NEC compared to the control group (3 versus 6). Furthermore, in the HIV-exposed group, the incidence of NEC differed significantly for Bell’s staging criteria. In the HIV-exposed group, two infants from the intervention group developed Bell’s stage I NEC and two infants from the control group developed Bell’s stage III NEC.

This study concluded that premature VLBW infants who received probiotics (L. rhamnosus GG and B. infantis) had a lower incidence of NEC compared to those in the control group. This effect was noted irrespective of the HIV status of the infant. In HIV-exposed premature infants, probiotics did not lower the incidence of NEC, although it lowered disease severity.

News source: Van Niekerk E, Nel DG, Blaauw R, et al. Probiotics reduce necrotizing enterocolitis severity in HIV-exposed premature infants. J Trop Pediatr. 2015;61(3):155–164.