Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Data Extraction and Meta-Analysis
3. Results
Literature Search
4. Methodological Study Quality
5. Discussion
6. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Author, Year | Study Details | Study Population | Intervention Specie | Milk | Placebo | FEF Definition |
---|---|---|---|---|---|---|
Dose (D) | ||||||
Start of Treatment (S) | ||||||
End of Treatment (E) | ||||||
Bin-Nun, 2005 [40] | P | Preterm infants with BW < 1500 g, who began enteral feeding on a weekday | B. infantis, Str. thermophilus, B. bifidus | OMM, PFM | HM or FM | 100 mL/kg/day |
B | D: 0.35 × 109 CFU each, OD | |||||
R | S: start of enteral feeding | |||||
C | E: 36 w postconceptual age | |||||
Braga, 2011 [60] | P | Inborn infants with BW 750–1499 g | L. casei, B. Breve | HM (± PFM from w3) | Extra HM | 150 mL/kg/day |
DB | D: 3.5 × 107 CFU to 3.5 × 109 CFU OD | |||||
R | S: day 2 | |||||
C | E: day 30, NEC diagnosis, discharge, death, whichever occurred first | |||||
Costalos, 2003 [41] | P | GA 28–32 w | Saccharomyces boulardii | PFM | MDX | Not defined |
R | No major GI problem | D: 1 × 109 CFU BD | ||||
C | Not receiving antibiotics | S: non-specified | ||||
Not receiving breast milk | Median duration of probiotic supplementation: 30 days | |||||
Costeloe, 2015 [64] | P | Preterm infants with GA 23–30 + 6 weeks, without any lethal malformation or any malformation of the GI tract | Bifidobacterium breve BBG-001 | OMM, DHM, FM | Corn starch powder | 150 mL/kg/day |
DB | D: 8 · 3–8 · 8 log10 CFU/day | |||||
R | S: as soon as possible after randomisation | |||||
C | E: 36 w PMA or discharge if sooner | |||||
Multic. | ||||||
Demirel, 2013 [27] | P | Preterm infants with GA ≤ 32 weeks and BW ≤ 1500 g, who survived to feed enterally | S. boulardii | HM, FM | None | Not defined |
B | D: 5 × 109 CFU OD | |||||
R | S: first feed | |||||
C | E: discharge | |||||
Dilli, 2015 [49] | P | Preterm infants with GA < 32 weeks and BW < 1500 g, born at or transferred to the NICU within the first week of life and fed enterally before inclusion | B. lactis | HM, FM | MDX powder | 100 mL/kg/day (FEF for hydration) |
DB | D: 5 × 109 CFU | 150 mL/kg/day (FEF for growth) | ||||
R | S: beyond d7 after birth | |||||
C | E: death or discharge (max 8 weeks) | |||||
Multic. | ||||||
Fernández-Carrocera, 2013 [30] | P | Preterm infants with | L. acidophilus 1 × 109 CFU/g, L. rhamnosus 4.4 × 108 CFU/g, L. casei 1 × 109 CFU/g, L. plantarum 1.76 × 108 CFU/g, B. infantis 2.76 × 107 CFU/g, Str. thermophilus 6.6 × 105 CFU/g | OMM, PFM | None | Not defined |
DB | BW < 1500 g | Total D: 1 g powder OD | ||||
R | Infants with NEC stage IA and stage IB were excluded | S: start of enteral feeding | ||||
C | E: non specified | |||||
Hays, 2014 [66] | P | Preterm infants with GA 25–31 weeks, BW 700–1600 g, AGA, enteral feeding initiated before day 5 | Probiotic group composed of 3 subgroups: | OMM, DM or PFM | MDX | Not defined |
DB | Infants with NEC stage ≥ IB, malformations or severe medical or surgical conditions were excluded | P1 B. lactis | ||||
R | P2 B. longum | |||||
C | P3 B. lactis + longum | |||||
Multic. | D: 1 × 109 CFU each probiotic daily | |||||
Duration: 4 weeks for infants ≥29 w/6 weeks for infants ≤28 w GA | ||||||
Hikaru, 2010 [68] | P | Extremely low birth weight and very low birth weight infants | B. breve | OMM, PFM | None | Not defined |
R | D: 0.5 × 109 CFU BD | |||||
C | S: birth | |||||
E: discharge from NICU | ||||||
Jacobs, 2013 [25] | P | Preterm infants with GA <32 weeks and BW < 1500 g | B. infantis BB-02 300 CFU × 106, Str. thermophilus Th-4 350 CFU × 106, B. lactis BB-12 350 CFU × 106 | HM, FM | MDX powder | Enteral feeds of 120 mL/kg for ≥3 days |
DB | Total D: 1 × 109 CFU × 1.5 g MDX powder OD | |||||
R | S: enteral feed ≥ 1 mL every 4 h | |||||
C | E: discharge or term corrected age | |||||
Multic. | ||||||
Lin, 2008 [39] | P | Preterm infants with GA < 34 weeks and BW ≤ 1500 g, who survived to feed enterally | L. acidophilus NCDO 1746, B. bifidum NCDO 1453 109 CFU | HM, FM | None | Oral intake of 100 mL/kg/day |
B | D: 1 × 109 CFU each probiotic (= 125 mg/kg) BD | |||||
R | S: day 2 of age | |||||
C | Duration: 6 weeks | |||||
Multic. | ||||||
Manzoni, 2006 [56] | P | Infants with BW < 1500 g, ≥3 day of life, who started enteral feeding with HM | L. casei subspecies rhamnosus LGG | OMM, DM | None | Not defined |
DB | D: 6 × 109 CFU/day | |||||
R | S: day 3 of life | |||||
C | E: end of the 6th week or discharge | |||||
Mihatsch, 2010 [36] | P | Preterm infants with GA < 30 weeks and BW ≤ 1500 g | B. lactis BB12 | OMM, PFM | Indistinguishable powder | 150 mL/kg/day |
R | D: 2 × 109 CFU/kg 6 times a day | |||||
C | S: start of enteral feeding | |||||
E: non specified | ||||||
Oncel, 2014 [24] | P | Preterm infants with GA ≤ 32 weeks and BW ≤ 1500 g, who survived to feed enterally | L. reuteri DSM 17938 | HM, FM | Oil base | Not defined |
DB | D: 1 × 108 CFU OD | |||||
R | S: first feed | |||||
C | E: death or discharge | |||||
Patole, 2014 [23] | P | Preterm infants with GA < 33 weeks and BW < 1500 g | B. breve | HM, FM | Dextrin | 150 mL/kg/day enteral feeding |
DB | D: 3 × 109 CFU OD (1.5 × 109 CFU OD for newborn ≤ 27 w until they reached 50 mL/kg/day enteral feeds) | |||||
R | S: start of enteral feed | |||||
C | E: corrected age of 37 w | |||||
Rougé, 2009 [37] | P | Preterm infants with GA < 32 weeks and BW < 1500 g, ≤2 weeks of age, without any disease other than those linked to prematurity, who started enteral feeding before inclusion | B. longum BB536, L. rhamnosus GG BB536-LGG | OMM, DM or PFM | MDX | Not defined |
DB | Total D: 1 × 108 CFU/day | |||||
R | S: start of enteral feeding | |||||
C | E: discharge | |||||
Bic. | ||||||
Roy, 2014 [50] | P | Preterm infants (GA < 37 weeks) and BW < 2500 g, with stable enteral feeding within 72 h of birth | L. acidophilus 1.25 × 109 CFU × 1 g, B. longum 0.125 × 109 CFU × 1 g, B. bifidum 0.125 × 109 CFU × 1 g, B. lactis 1 × 109 CFU × 1 g | HM | Sterile water | 120 mL/kg/day for ≥3 d |
DB | D: half a 1 g sachet | |||||
R | S: from 72 h of life | |||||
C | E: after 6 w or at discharge | |||||
Saengtawesin, 2014 [48] | P | Preterm infants with GA ≤ 34 weeks and BW ≤ 1500 g | L. acidophilus 1 × 109 CFU, B. bifidum 1 × 109 CFU | HM, PFM | None | 150 mL/kg/day |
R | D: 125 mg/kg BD | |||||
C | S: start of feeding | |||||
E: 6 w of age or discharge. | ||||||
Samanta, 2008 [38] | P | Preterm infants with GA < 32 weeks and BW < 1500 g, who started enteral feeding and survived beyond 48 h of age | B. infantis, B. bifidum, B. longum, L. acidophilus | HM | None | Not defined |
DB | ||||||
R | D: 2.5 × 109 CFU each probiotic, BD | |||||
C | S: start of enteral feeding | |||||
E: discharge | ||||||
Sari, 2011 [34] | P | Preterm infants with GA < 32 weeks or BW < 1500 g, who survived to feed enterally | L. sporogenes | HM, FM | None | Not defined |
B | D: 0.35 × 109 CFU OD | |||||
R | S: first feed | |||||
C | E: discharge | |||||
Serce, 2013 [26] | P | Preterm infants with GA ≤ 32 weeks and BW ≤ 1500 g, who survived to feed enterally | S. boulardii | HM, FM | Distilled water | 100 mL/kg/day |
M | D: 0.5 × 109 CFU/kg BD | enteral feeding | ||||
R | S: non specified | |||||
C | E: non specified | |||||
Stratiki, 2007 [61] | P | Preterm infants with GA 27–32 weeks, formula-fed, without major congenital anomalies | Bifidobacterium lactis | FM | None | 150 mL/kg/day |
B | D: 2 × 107 CFU/g of milk powder | |||||
R | S: start of enteral feeding | |||||
C | E: not specified | |||||
Tewari, 2015 [70] | P | Preterm infants with GA < 34 weeks | Bacillus clausii | OMM, DHM | Sterile water | 180 mL/kg/day |
DB | Excluded if: NEC, congenital anomaly , outborn and >10 days of with sepsis | D: 2.4 × 109 CFU/day | ||||
R | Stratified as extreme preterm (GA 27–30 + 6) and very preterm (GA 31–33 + 6) | S: by day 5 in asymptomatic and by day 10 in symptomatic infants | ||||
C | E: 6 weeks of age, discharge or death (whichever occurred first) | |||||
Totsu, 2014 [21] | P | Infants with BW < 1500 g | B. bifidum | HM, FM | Dextrin | Postnatal day at which the amount of enteral feeding exceeded 100 mL/kg/day |
DB | D: 2.5 × 109 CFU, divided in two doses | |||||
CLR | S: within 48 h after birth | |||||
C | E: body weight 2000 g | |||||
Multic. | ||||||
Van Niekerk, 2014 [22] | P | Preterm infants with GA < 34 weeks and BW < 1250 g, exposed and non-exposed to HIV (only infants unexposed to HIV are included in the meta-analysis) | L. rhamnosus, B. infantis | HM | MCT oil | “when infants no longer required the use of IV fluids” |
DB | D: 0.35 × 109 CFU each probiotic | |||||
R | S: start of enteral feeding | |||||
C | E: day 28 postconceptual age |
Study | Random Sequence Generation | Allocation Concealment | Blinding | Incomplete Outcome Data | Selective Outcome Reporting | Other Sources of Bias |
---|---|---|---|---|---|---|
Braga, 2011 [60] | Low | Low | Low | Low | Unclear | Low |
Manzoni, 2006 [56] | Low | Low | Low | Unclear | Unclear | Low |
Roy, 2014 [50] | Low | Unclear | Low | Low | Unclear | Unclear |
Samanta, 2008 [38] | Low | Low | Low | Unclear | Unclear | Unclear |
Van Niekerk, 2014 [22] | Low | Unclear | Low | Unclear | Unclear | Unclear |
© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
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Aceti, A.; Gori, D.; Barone, G.; Callegari, M.L.; Fantini, M.P.; Indrio, F.; Maggio, L.; Meneghin, F.; Morelli, L.; Zuccotti, G.; et al. Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis. Nutrients 2016, 8, 471. https://doi.org/10.3390/nu8080471
Aceti A, Gori D, Barone G, Callegari ML, Fantini MP, Indrio F, Maggio L, Meneghin F, Morelli L, Zuccotti G, et al. Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis. Nutrients. 2016; 8(8):471. https://doi.org/10.3390/nu8080471
Chicago/Turabian StyleAceti, Arianna, Davide Gori, Giovanni Barone, Maria Luisa Callegari, Maria Pia Fantini, Flavia Indrio, Luca Maggio, Fabio Meneghin, Lorenzo Morelli, Gianvincenzo Zuccotti, and et al. 2016. "Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis" Nutrients 8, no. 8: 471. https://doi.org/10.3390/nu8080471