- 2022-02
- BMJ open gastroenterology 9(1)
- Gayatri Athalye-Jape
- Meera Esvaran
- Sanjay Patole
- Karen Simmer
- Elizabeth Nathan
- Dorota Doherty
- Anthony Keil
- Shripada Rao
- Liwei Chen
- Lakshmi Chandrasekaran
- Chooi Kok
- Stephan Schuster
- Patricia Conway
Study Design
- Type
- Randomized Controlled Trial (RCT)
- Population
- 173 extremely preterm infants (gestational age <28 weeks)
- Methods
- Randomized controlled trial, triple-strain vs single-strain probiotic supplementation, commencing with feeds until 37 weeks corrected gestational age
- Funding
- Unclear
Objective
Evidence indicates that multistrain probiotics benefit preterm infants more than single-strain (SS) probiotics. We assessed the effects of SS versus triple-strain (TS) probiotic supplementation (PS) in extremely preterm (EP) infants.Design
EP infants (gestational age (GA) <28 weeks) were randomly allocated to TS or SS probiotic, assuring blinding. Reference (REF) group was EP infants in the placebo arm of our previous probiotic trial. PS was commenced with feeds and continued until 37 weeks' corrected GA. Primary outcome was time to full feed (TFF: 150 mL/kg/day). Secondary outcomes included short-chain fatty acids and faecal microbiota collected at T1 (first week) and T2 (after 3 weeks of PS) using 16S ribosomal RNA gene sequencing.Results
173 EP (SS: 86, TS: 87) neonates with similar GA and birth weight (BW) were randomised. Median TFF was comparable (11 (IQR 8-16) vs 10 (IQR 8-16) days, p=0.92). Faecal propionate (SS, p<0.001, and TS, p=0.0009) and butyrate levels (TS, p=0.029) were significantly raised in T2 versus T1 samples. Secondary clinical outcomes were comparable. At T2, alpha diversity was comparable (p>0.05) between groups, whereas beta-diversity analysis revealed significant differences between PS and REF groups (both p=0.001). Actinobacteria were higher (both p<0.01), and Proteobacteria, Firmicutes and Bacteroidetes were lower in PS versus REF. Gammaproteobacteria, Clostridia and Negativicutes were lower in both PS versus REF.Conclusion
TFF in EP infants was similar between SS and TS probiotics. Both probiotics were effective in reducing dysbiosis (higher bifidobacteria and lower Gammaproteobacteria). Long-term significance of increased propionate and butyrate needs further studies.Trial registration number
ACTRN 12615000940572.