A comprehensive Canadian retrospective cohort study has demonstrated that probiotic supplementation significantly reduces mortality rates in preterm and low-birth-weight infants, despite not affecting the incidence of common life-threatening conditions in this vulnerable population.
The research, led by Dr. Belal Alshaikh from the University of Calgary, analyzed data from 32,667 infants born before 34 weeks' gestation. The findings revealed that probiotic supplementation was associated with a 38% reduction in mortality rates (adjusted odds ratio 0.62, 98.3% CI 0.53-0.73).
Impact on Extremely Low Birth Weight Infants
The mortality benefit was particularly pronounced in infants weighing less than 1,000 grams at birth. Among 7,401 such infants, probiotic use corresponded with a 42% reduction in mortality rates (aOR 0.58, 98.3% CI 0.47-0.71).
Safety and Complications
Despite the positive impact on survival, the study found no significant reduction in two major complications affecting preterm infants:
- Necrotizing enterocolitis (NEC): aOR 0.92, 98.3% CI 0.78-1.09
- Late-onset sepsis: aOR 0.90, 98.3% CI 0.80-1.01
Necrotizing enterocolitis, a condition characterized by intestinal inflammation and bacterial invasion, remains a significant concern with mortality rates reaching up to 50% in affected infants.
Safety Profile and Rare Complications
The study documented rare instances of probiotic sepsis, occurring in:
- 27 infants born before 34 weeks gestation
- 20 infants with birth weight below 1,000 grams
Of the three reported deaths associated with probiotic sepsis, the condition was considered a possible contributing factor in two cases.
Expert Perspectives
In an accompanying editorial, Dr. Roger Soll and Dr. Erika Edwards from the University of Vermont highlighted the reassuring nature of these findings, particularly regarding the effectiveness in extremely low birth weight infants and the rare occurrence of probiotic sepsis.
However, they emphasized several areas requiring further investigation:
- Optimal probiotic species selection
- Role of breastfeeding in conjunction with probiotic supplementation
- Improvements in breast milk handling and feeding practices
Current Challenges and Future Directions
The varied adoption of probiotics across neonatal intensive care units (NICUs) reflects ongoing concerns about:
- Limited availability of pharmaceutical-grade products
- Moderate certainty regarding efficacy
- Potential risks, albeit rare
The persistent challenge of reducing necrotizing enterocolitis rates over the past decade underscores the urgent need for developing effective, regulatory-compliant probiotic products for this vulnerable patient population.
