Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

• Main Authors: Isadora Beghetti, Davide Panizza, Jacopo Lenzi, Davide Gori, Silvia Martini, Luigi Corvaglia, Arianna Aceti
• Format: Article
• Language: English
• Published: MDPI AG 2021-01-01
• Series: Nutrients
• Subjects: necrotizing enterocolitis; preterm infants; probiotics; systematic review; network meta-analysis
• Online Access: https://www.mdpi.com/2072-6643/13/1/192

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, <i>Lactobacillus acidophilus</i> LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00–0.21). The subgroup analysis showed that <i>Bifidobacterium lactis</i> Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01–0.49 vs. OR 0.32; 95% CrIs 0.10–0.36). Conclusions: <i>B. lactis</i> Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.