Rath Chandra, Athalye-Jape Gayatri, Rao Shripada, Patole Sanjay
Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA 6008, Australia.
Neonatal Directorate, Perth Children's Hospital, Nedlands, WA 6009, Australia.
Children (Basel). 2023 Oct 20;10(10):1710. doi: 10.3390/children10101710.
Probiotics are known to decrease incidences of necrotising enterocolitis, feeding intolerance, late-onset sepsis, and mortality in preterm infants. Administering an adequate dose is important for optimizing the benefits and safety of probiotics. We conducted a systematic review to assess the effect of probiotic dose escalation on clinical outcomes and gut microbiota in preterm neonates. We searched PubMed, EMBASE, EMCARE, Medline, Cochrane Library, Google Scholar, and MedNar databases in July 2023. Three studies were included. In one of the randomized studies ( = 149, gestation 27 to 33 weeks), no significant differences in faecal and counts and clinical outcomes were seen between the high- and low-dose groups. There was a trend towards increased and counts in the high-dose group. In the other randomized study ( = 120, birth weight 500 to 2000 gm), smaller infants (500 to 1000 gm) required higher doses to display in their faeces. The cohort study ( = 12, gestation < 33 weeks) showed a trend towards an increase in faecal abundance of bifidobacteria and bacterial diversity in the group with increasing dose/time. Limited evidence suggests a higher dose might improve gut colonization in preterm infants. Further studies are urgently needed to address this gap in the knowledge considering the increasing use of probiotics for preterm infants.
已知益生菌可降低早产儿坏死性小肠结肠炎、喂养不耐受、迟发性败血症的发生率及死亡率。给予足够剂量对于优化益生菌的益处和安全性很重要。我们进行了一项系统评价，以评估益生菌剂量增加对早产新生儿临床结局和肠道微生物群的影响。我们于2023年7月检索了PubMed、EMBASE、EMCARE、Medline、Cochrane图书馆、谷歌学术和MedNar数据库。纳入了三项研究。在其中一项随机研究中（n = 149，孕周27至33周），高剂量组和低剂量组在粪便双歧杆菌和乳酸杆菌计数及临床结局方面未见显著差异。高剂量组有双歧杆菌和乳酸杆菌计数增加的趋势。在另一项随机研究中（n = 120，出生体重500至2000克），较小的婴儿（500至1000克）需要更高剂量才能在粪便中显示出双歧杆菌。队列研究（n = 12，孕周< 33周）显示，随着剂量/时间增加，双歧杆菌组粪便中双歧杆菌丰度和细菌多样性有增加趋势。有限的证据表明，较高剂量可能改善早产儿的肠道定植。考虑到益生菌在早产儿中的使用日益增加，迫切需要进一步研究来填补这一知识空白。
