Aveline Alice, Szatkowski Lisa, Berrington Janet, Costeloe Kate, Bottle Alex, Ojha Shalini, Fleming Paul, Battersby Cheryl
Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
Centre for Paediatrics and Child Health, Imperial College London, London, UK.
BMJ Paediatr Open. 2025 Jul 24;9(1):e003605. doi: 10.1136/bmjpo-2025-003605.
To describe the use of probiotics among preterm infants in neonatal units and explore factors that influence exposure.
Observational study using prospectively recorded health data.
England and Wales.
48 048 infants born at <32 weeks gestational age (GA) and admitted to a neonatal unit between 1 January 2016 and 31 December 2022.
Measures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).
The proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29 weeks (IQR 27-30). Probiotics were started on median day 5 (IQR 2-8), earlier for those born at >28 weeks GA (median day 4, IQR 2-7), most frequently after enteral feeds (66% of exposed infants) and were usually discontinued between 32 and 36 weeks postmenstrual age (PMA) (47% at 32-33 weeks PMA, 33% at 34-35 weeks PMA). Among infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born <32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestational age, lower birth weight z score and higher illness severity score or were more mature.
By 2022, over half of infants born at <32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around the safety and efficacy of probiotics.
描述新生儿病房中早产儿使用益生菌的情况，并探讨影响其接触益生菌的因素。
利用前瞻性记录的健康数据进行观察性研究。
英格兰和威尔士。
2016年1月1日至2022年12月31日期间出生且胎龄小于32周（GA）并入住新生儿病房的48048名婴儿。
益生菌使用情况的测量指标（接触益生菌的婴儿数量和比例、首次接触益生菌的出生后年龄以及停用时间）。
在研究期间，接受益生菌的婴儿比例从9%增加到54%。接受益生菌的婴儿的中位胎龄为29周（四分位间距27 - 30周）。益生菌开始使用的中位时间为出生后第5天（四分位间距2 - 8天），胎龄大于28周的婴儿开始使用时间更早（中位时间为出生后第4天，四分位间距2 - 7天），大多数在开始肠内喂养后使用（66%的接触婴儿），通常在月经后年龄（PMA）32至36周之间停用（32 - 周33周PMA时为47%，34 - 35周PMA时为33%）。在使用益生菌的新生儿重症监护病房（定义为胎龄小于32周的婴儿中有50%或更多接触益生菌的病房）接受护理的婴儿中，23%从未使用过益生菌。未使用益生菌的婴儿胎龄更低、出生体重z评分更低、疾病严重程度评分更高或更成熟。
到2022年，超过一半的胎龄小于32周的婴儿接触过益生菌，但尽管在使用益生菌的病房，仍有近四分之一的婴儿未接受益生菌。我们的研究结果有助于对观察性数据进行解读，并为未来研究的设计提供参考，这些研究旨在解决围绕益生菌安全性和有效性的持续不确定性问题。
