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Open AccessArticle

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

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Department of Pediatrics, University of Lübeck, 23562 Lübeck, Germany
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German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, 38124 Braunschweig, Germany
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Department of Pediatrics, Vestische Children’s Hospital Datteln, 45711 Datteln, Germany
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Department of Neonatology, Hannover Medical School, 30159 Hannover, Germany
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Center for Pediatrics and Adolescent Medicine, Medical Center and Medical Faculty, University of Freiburg, 79098 Freiburg, Germany
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Institute for Immunodeficiency, Medical Center and Medical Faculty, University of Freiburg, 79098 Freiburg, Germany
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Children’s Hospital Links der Weser Bremen, 28277 Bremen, Germany
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Department of Neonatology and General Pediatrics, University of Essen, 45147 Essen, Germany
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Department of Neonatology and General Pediatrics, Saar University of Homburg, 66424 Homburg, Germany
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Children’s Hospital Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
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Department of Infectious Diseases and Medical Microbiology, University of Lübeck, 23562 Lübeck, Germany
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(3), 850; https://doi.org/10.3390/nu12030850
Received: 25 February 2020 / Revised: 16 March 2020 / Accepted: 20 March 2020 / Published: 22 March 2020
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. View Full-Text
Keywords: probiotic prophylaxis; human milk; prematurity; sepsis; growth failure probiotic prophylaxis; human milk; prematurity; sepsis; growth failure
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Fortmann, I.; Marißen, J.; Siller, B.; Spiegler, J.; Humberg, A.; Hanke, K.; Faust, K.; Pagel, J.; Eyvazzadeh, L.; Brenner, K.; Roll, C.; Pirr, S.; Viemann, D.; Stavropoulou, D.; Henneke, P.; Tröger, B.; Körner, T.; Stein, A.; Derouet, C.; Zemlin, M.; Wieg, C.; Rupp, J.; Herting, E.; Göpel, W.; Härtel, C. Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk. Nutrients 2020, 12, 850.

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