Preterm infants with birth weights less than 1000 grams, so called extremely low birth weight (ELBW) infants, have an increased risk for necrotizing enterocolitis (NEC). Probiotics have been demonstrated to reduce the risk of NEC for preterm infants. However, many neonatal intensive care units (NICUs) do not use routine probiotic prophylaxis because of safety concerns. This retrospective analysis aimed to assess and evaluate the effect of probiotics on NEC and bloodstream infections (BSI) in ELBW infants before and after their implementation in German neonatal intensive care units (NICUs).
This multicenter study is based on NEO-KISS, the German surveillance system for nosocomial infections in preterm infants. All NICUs that implemented use of probiotics for ELBW infants were included in the analysis. Of these departments, all patients that were admitted between 36 months before and 36 months after the start of exposure (probiotics) were used for this analysis. Interrupted time series analyses were applied to evaluate longitudinal effects of probiotics on the frequency of preterm complications between 2004 and 2014. Risk factor analyses included Cox proportional hazard regression estimating hazard ratios (HR) with 95 % confidence intervals (95 % CI).
Data from 4,683 ELBW infants on 44 neonatal wards was included in this study. Incidence of NECs and nosocomial BSI were 4.6 % (n = 215) and 24.2 %, (n = 1133), respectively. The use of probiotics significantly reduced the risk of NEC (HR = 0.48; 95% CI = 0.36 – 0.64), overall mortality (HR = 0.59, 95 % CI = 0.41 – 0.84) and mortality after NEC (HR = 0.40, 95 % CI = 0.19 – 0.85). In addition, a mild protective effect on nosocomial BSI (HR = 0.83, 95 % CI = 0.87 – 0.94) could be observed.
In order to reduce NEC and mortality in ELBW infants, it is advisable to add routine probiotic prophylaxis to clinical practice on neonatal wards as soon as possible.
L. A. Denkel,
L. Garten, None
C. Geffers, None
P. Gastmeier, None
B. Piening, None