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Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

  • 2020-03-22
  • Nutrients 12(3)
    • Ingmar Fortmann
    • J. Marissen
    • Bastian Siller
    • J. Spiegler
    • Alexander Humberg
    • Kathrin Hanke
    • Kirstin Faust
    • Julia Pagel
    • Leila Eyvazzadeh
    • Kim Brenner
    • C. Roll
    • S. Pirr
    • D. Viemann
    • D. Stavropoulou
    • P. Henneke
    • Birte Tröger
    • Thorsten Körner
    • A. Stein
    • Christoph Derouet
    • M. Zemlin
    • C. Wieg
    • J. Rupp
    • E. Herting
    • W. Göpel
    • C. Härtel

Abstract

Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth.

Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models.

Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82-4.35; p < 0.001) but not in the F group (effect size B = -0.06; 95% CI: -3.05-0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59-0.79; p < 0.001).

Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

Keywords: growth failure; human milk; prematurity; probiotic prophylaxis; sepsis.

Research Insights

SupplementHealth OutcomeEffect TypeEffect Size
Bifidobacterium infantisImproved GrowthBeneficial
Large
Bifidobacterium infantisReduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis BI02Improved Growth RateBeneficial
Large
Bifidobacterium infantis BI02Reduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis HA-116Improved Growth in InfantsBeneficial
Large
Bifidobacterium infantis HA-116Reduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis M-63Improved Growth RateBeneficial
Large
Bifidobacterium infantis M-63Reduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis MAK22B04IImproved Growth RateBeneficial
Large
Bifidobacterium infantis MAK22B04IReduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis SD-6720Improved GrowthBeneficial
Large
Bifidobacterium infantis SD-6720Reduced Incidence of Clinical SepsisBeneficial
Moderate
Bifidobacterium infantis VPro 53Improved GrowthBeneficial
Large
Bifidobacterium infantis VPro 53Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilusImproved Growth in Human Milk-fed InfantsBeneficial
Large
Lactobacillus acidophilusReduced Sepsis IncidenceBeneficial
Moderate
Lactobacillus acidophilus HA-122Improved Growth in Human Milk-fed InfantsBeneficial
Large
Lactobacillus acidophilus HA-122Reduced Sepsis IncidenceBeneficial
Moderate
Lactobacillus acidophilus L-92Improved Growth RateBeneficial
Large
Lactobacillus acidophilus L-92Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus LA-02Improved GrowthBeneficial
Large
Lactobacillus acidophilus LA-02Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus La-14Improved Growth RateBeneficial
Large
Lactobacillus acidophilus La-14Reduced Sepsis IncidenceBeneficial
Moderate
Lactobacillus acidophilus LA-5Improved GrowthBeneficial
Large
Lactobacillus acidophilus LA-5Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus LA85Improved GrowthBeneficial
Large
Lactobacillus acidophilus LA85Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus MAK32L61AImproved Daily Weight GainBeneficial
Large
Lactobacillus acidophilus MAK32L61AReduced Sepsis IncidenceBeneficial
Moderate
Lactobacillus acidophilus NCIMB 30333Improved GrowthBeneficial
Large
Lactobacillus acidophilus NCIMB 30333Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus R0418Improved GrowthBeneficial
Large
Lactobacillus acidophilus R0418Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus SD-5212Improved Weight GainBeneficial
Large
Lactobacillus acidophilus SD-5212Reduced Incidence of Clinical SepsisBeneficial
Moderate
Lactobacillus acidophilus UALa01Improved Weight GainBeneficial
Large
Lactobacillus acidophilus UALa01Reduced Clinical SepsisBeneficial
Small
Lactobacillus acidophilus UALa01Reduced Incidence of Clinical SepsisBeneficial
Moderate

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