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
- PubMed: 32235769
- DOI: 10.3390/nu12030850
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
| Supplement | Health Outcome | Effect Type | Effect Size |
|---|---|---|---|
| Bifidobacterium infantis | Improved Growth | Beneficial | Large |
| Bifidobacterium infantis | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis BI02 | Improved Growth Rate | Beneficial | Large |
| Bifidobacterium infantis BI02 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis HA-116 | Improved Growth in Infants | Beneficial | Large |
| Bifidobacterium infantis HA-116 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis M-63 | Improved Growth Rate | Beneficial | Large |
| Bifidobacterium infantis M-63 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis MAK22B04I | Improved Growth Rate | Beneficial | Large |
| Bifidobacterium infantis MAK22B04I | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis SD-6720 | Improved Growth | Beneficial | Large |
| Bifidobacterium infantis SD-6720 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Bifidobacterium infantis VPro 53 | Improved Growth | Beneficial | Large |
| Bifidobacterium infantis VPro 53 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus | Improved Growth in Human Milk-fed Infants | Beneficial | Large |
| Lactobacillus acidophilus | Reduced Sepsis Incidence | Beneficial | Moderate |
| Lactobacillus acidophilus HA-122 | Improved Growth in Human Milk-fed Infants | Beneficial | Large |
| Lactobacillus acidophilus HA-122 | Reduced Sepsis Incidence | Beneficial | Moderate |
| Lactobacillus acidophilus L-92 | Improved Growth Rate | Beneficial | Large |
| Lactobacillus acidophilus L-92 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus LA-02 | Improved Growth | Beneficial | Large |
| Lactobacillus acidophilus LA-02 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus La-14 | Improved Growth Rate | Beneficial | Large |
| Lactobacillus acidophilus La-14 | Reduced Sepsis Incidence | Beneficial | Moderate |
| Lactobacillus acidophilus LA-5 | Improved Growth | Beneficial | Large |
| Lactobacillus acidophilus LA-5 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus LA85 | Improved Growth | Beneficial | Large |
| Lactobacillus acidophilus LA85 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus MAK32L61A | Improved Daily Weight Gain | Beneficial | Large |
| Lactobacillus acidophilus MAK32L61A | Reduced Sepsis Incidence | Beneficial | Moderate |
| Lactobacillus acidophilus NCIMB 30333 | Improved Growth | Beneficial | Large |
| Lactobacillus acidophilus NCIMB 30333 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus R0418 | Improved Growth | Beneficial | Large |
| Lactobacillus acidophilus R0418 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus SD-5212 | Improved Weight Gain | Beneficial | Large |
| Lactobacillus acidophilus SD-5212 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |
| Lactobacillus acidophilus UALa01 | Improved Weight Gain | Beneficial | Large |
| Lactobacillus acidophilus UALa01 | Reduced Clinical Sepsis | Beneficial | Small |
| Lactobacillus acidophilus UALa01 | Reduced Incidence of Clinical Sepsis | Beneficial | Moderate |