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Nutrients 2016, 8(8), 471; doi:10.3390/nu8080471

Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis

Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, S.Orsola-Malpighi Hospital, Bologna 40138, Italy
Task Force on Probiotics of the Italian Society of Neonatology, Milan 20126, Italy
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna 40138, Italy
Neonatal Unit, Catholic University, Rome 00168, Italy
Institute of Microbiology, UCSC, Piacenza 29122, Italy
Department of Pediatrics, Aldo Moro University, Bari 70124, Italy
Study Group of Neonatal Gastroenterology and Nutrition of the Italian Society of Neonatology, Milan 20126, Italy
Division of Neonatology, Children Hospital V. Buzzi, ICP, Milan 20154, Italy
Department of Pediatrics, Children Hospital V. Buzzi, University of Milan, Milan 20154, Italy
Author to whom correspondence should be addressed.
Received: 13 June 2016 / Revised: 17 July 2016 / Accepted: 26 July 2016 / Published: 30 July 2016
(This article belongs to the Special Issue Nutrients in Infancy)
View Full-Text   |   Download PDF [1189 KB, uploaded 30 July 2016]   |  


Probiotics have been linked to a reduction in the incidence of necrotizing enterocolitis and late-onset sepsis in preterm infants. Recently, probiotics have also proved to reduce time to achieve full enteral feeding (FEF). However, the relationship between FEF achievement and type of feeding in infants treated with probiotics has not been explored yet. The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics in reducing time to achieve FEF in preterm infants, according to type of feeding (exclusive human milk (HM) vs. formula). Randomized-controlled trials involving preterm infants receiving probiotics, and reporting on time to reach FEF were included in the systematic review. Trials reporting on outcome according to type of feeding (exclusive HM vs. formula) were included in the meta-analysis. Fixed-effect or random-effects models were used as appropriate. Results were expressed as mean difference (MD) with 95% confidence interval (CI). Twenty-five studies were included in the systematic review. In the five studies recruiting exclusively HM-fed preterm infants, those treated with probiotics reached FEF approximately 3 days before controls (MD −3.15 days (95% CI −5.25/−1.05), p = 0.003). None of the two studies reporting on exclusively formula-fed infants showed any difference between infants receiving probiotics and controls in terms of FEF achievement. The limited number of included studies did not allow testing for other subgroup differences between HM and formula-fed infants. However, if confirmed in further studies, the 3-days reduction in time to achieve FEF in exclusively HM-fed preterm infants might have significant implications for their clinical management. View Full-Text
Keywords: probiotics; preterm infants; human milk; full enteral feeding; systematic review probiotics; preterm infants; human milk; full enteral feeding; systematic review

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC 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.; Corvaglia, L. 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.

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