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Date of Award
Spring 2020
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Jodi Freeman
Abstract
Introduction: Necrotizing Enterocolitis (NEC) is a deadly gastrointestinal emergency seen most commonly in premature infants. Symptoms include abdominal distension, diarrhea, vomiting, poor feeding, and bloody stool. Treatments include discontinuing regular feedings, NG tube placement, antibiotic therapy, frequent blood and stool tests, and mechanical ventilation if abdominal distension interferes with breathing. If medical treatment fails, surgical intervention is required and includes removal of the damaged intestine with temporary ostomy placement. There are many negative health outcomes following a NEC diagnosis, making preventative therapy of particular interest to researchers. Numerous studies have shown the efficacy of probiotics in decreasing NEC occurrence, but few studies investigate which strains provide the best outcomes. The purpose of this literature review is to investigate NEC occurrence rates (O) in very low birth weight (VLBW) premature infants (P) after prophylactic treatment with single-strain (C) vs combination (I) probiotics.
Methods: A systematic review of literature was conducted through Cochrane Database of Systematic Reviews, PubMed, and Google Scholar in October and November of 2018. After narrowing down results using specific inclusion and exclusion criteria, including publication date, primary outcomes, and sample population, seven articles were chosen and included in this review.
Results: Based on literature review, there is evidence that multi-strain probiotics are more efficacious than single-strain probiotics in the prevention of NEC in very low birth weight infants. One of three studies investigating single-strain probiotics produced statistically significant results, while three of four studies using combination probiotics yielded statistically significant results. One study resulted in one episode of NEC in the probiotic group vs twenty in the control group. Overall, six of the seven studies used in this literature review identified clinically significant results, which was defined as a 50% reduction in NEC cases between groups.
Discussion: This literature review confirms what other studies have found, which is that probiotics prevent NEC in VLBW neonates. Every study ensured similar sample populations by implementing strict inclusion and exclusion criteria, however, evidence was inadequate in some areas due to dosing inconsistencies, different timelines for initiation of therapy, and differing bacterial species and strains. Generally, probiotic therapy should be considered safe in this population, as only one in 3,884 infants experienced bacteremia with the probiotic used.
Conclusion: Countries around the world have been using probiotics as prophylactic treatment to reduce the occurrence of NEC in premature infants for years, but this practice has not been widely accepted by neonatologists in the United States. This literature review included a total of seven articles and found that multi-strain probiotics appear to be superior to single-strain probiotics in the prevention of NEC. Further comparisons of probiotic to placebo groups are unlikely to alter this conclusion. Rather, future studies should focus on comparing different combinations of high-quality probiotics at varying doses and durations to identify those with superior outcomes.
Recommended Citation
Woodrow, Taylor, "Use of Single Versus Multi-Strain Probiotics to Decrease the Occurrence Of Necrotizing Enterocolitis in Very Low Birth Weight Infants" (2020). Capstone Showcase. 27.
https://scholarworks.arcadia.edu/showcase/2020/pa/27
Use of Single Versus Multi-Strain Probiotics to Decrease the Occurrence Of Necrotizing Enterocolitis in Very Low Birth Weight Infants
Introduction: Necrotizing Enterocolitis (NEC) is a deadly gastrointestinal emergency seen most commonly in premature infants. Symptoms include abdominal distension, diarrhea, vomiting, poor feeding, and bloody stool. Treatments include discontinuing regular feedings, NG tube placement, antibiotic therapy, frequent blood and stool tests, and mechanical ventilation if abdominal distension interferes with breathing. If medical treatment fails, surgical intervention is required and includes removal of the damaged intestine with temporary ostomy placement. There are many negative health outcomes following a NEC diagnosis, making preventative therapy of particular interest to researchers. Numerous studies have shown the efficacy of probiotics in decreasing NEC occurrence, but few studies investigate which strains provide the best outcomes. The purpose of this literature review is to investigate NEC occurrence rates (O) in very low birth weight (VLBW) premature infants (P) after prophylactic treatment with single-strain (C) vs combination (I) probiotics.
Methods: A systematic review of literature was conducted through Cochrane Database of Systematic Reviews, PubMed, and Google Scholar in October and November of 2018. After narrowing down results using specific inclusion and exclusion criteria, including publication date, primary outcomes, and sample population, seven articles were chosen and included in this review.
Results: Based on literature review, there is evidence that multi-strain probiotics are more efficacious than single-strain probiotics in the prevention of NEC in very low birth weight infants. One of three studies investigating single-strain probiotics produced statistically significant results, while three of four studies using combination probiotics yielded statistically significant results. One study resulted in one episode of NEC in the probiotic group vs twenty in the control group. Overall, six of the seven studies used in this literature review identified clinically significant results, which was defined as a 50% reduction in NEC cases between groups.
Discussion: This literature review confirms what other studies have found, which is that probiotics prevent NEC in VLBW neonates. Every study ensured similar sample populations by implementing strict inclusion and exclusion criteria, however, evidence was inadequate in some areas due to dosing inconsistencies, different timelines for initiation of therapy, and differing bacterial species and strains. Generally, probiotic therapy should be considered safe in this population, as only one in 3,884 infants experienced bacteremia with the probiotic used.
Conclusion: Countries around the world have been using probiotics as prophylactic treatment to reduce the occurrence of NEC in premature infants for years, but this practice has not been widely accepted by neonatologists in the United States. This literature review included a total of seven articles and found that multi-strain probiotics appear to be superior to single-strain probiotics in the prevention of NEC. Further comparisons of probiotic to placebo groups are unlikely to alter this conclusion. Rather, future studies should focus on comparing different combinations of high-quality probiotics at varying doses and durations to identify those with superior outcomes.