Lactobacillus reuteri DSM 17938 as a Probiotic for Preterm Neonates: A Strain-Specific Systematic Review.

2015-06-09
Journal of Parenteral and Enteral Nutrition 40(6)
- G. Athalye-Jape
- Shripada C Rao
- S. Patole

PubMed: 26059900
DOI: 10.1177/0148607115588113

Study Design

Type: Systematic Review
Population: Preterm neonates
Methods: Systematic Review

Abstract

Introduction: Prevention of necrotizing enterocolitis (NEC) while optimizing enteral nutrition (EN) is a priority in preterm neonates. Lactobacillus reuteri DSM 17938 (L reuteri) is known to improve gut motility. Previous systematic reviews have not adequately assessed the effects of L reuteri in improving feed tolerance in preterm neonates.

Objective: To assess the effects of L reuteri in preterm neonates.

Design: A systematic review of randomized controlled trials (RCTs) and non-RCTs of L reuteri was conducted. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL databases and proceedings of Pediatric Academic Society meetings in December 2014.

Results: Six RCTs (n = 1778) and 2 non-RCTs (n = 665) were included. Meta-analysis of RCTs estimated that the time to full feeds (mean difference [MD], -1.34 days; 95% confidence interval [CI], -1.81 to -0.86; 2 RCTs), duration of hospitalization (-10.77 days; 95% CI, -13.67 to -7.86; 3 RCTs), and late-onset sepsis (LOS) (relative risk [RR], 0.66; 95% CI, 0.52 to 0.83; 4 RCTs) were reduced in the L reuteri group. Mortality (RR, 0.79; 95% CI, 0.57-1.09; 3 RCTs) and ≥ stage II NEC (RR, 0.69; 95% CI, 0.47-1.01; 3 RCTs) were reduced but statistically not significant. There were no adverse effects of supplementation. Both non-RCT studies showed significant improvement in the incidence of NEC with L reuteri supplementation.

Conclusions: Evidence from a limited number of studies suggests that L reuteri supplementation has the potential to reduce the risk of NEC and LOS while facilitating EN in preterm infants. Larger definitive RCTs are needed to confirm these findings.

Keywords: enteral nutrition; life cycle; neonates; nutrition, probiotics; research and diseases.

Research Insights

Lactobacillus reuteri MAK02L14R→Reduced Colitis-Related Mortality
Mortality (RR, 0.79; 95% CI, 0.57-1.09; 3 RCTs) was reduced but statistically not significant.
Effect
Neutral
Effect size
Moderate
Lactobacillus reuteri MAK02L14R→Reduced Hospitalization Duration
Meta-analysis of RCTs estimated that the duration of hospitalization (-10.77 days; 95% CI, -13.67 to -7.86; 3 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Large
Lactobacillus reuteri MAK02L14R→Reduced Incidence of Late-Onset Sepsis
Meta-analysis of RCTs estimated that late-onset sepsis (LOS) (relative risk [RR], 0.66; 95% CI, 0.52 to 0.83; 4 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri MAK02L14R→Reduced Necrotizing Enterocolitis (NEC) Incidence, Stage II or Greater
≥ stage II NEC (RR, 0.69; 95% CI, 0.47-1.01; 3 RCTs) were reduced but statistically not significant.
Effect
Neutral
Effect size
Moderate
Lactobacillus reuteri MAK02L14R→Reduced Occurrence of Necrotizing Enterocolitis
Both non-RCT studies showed significant improvement in the incidence of NEC with L reuteri supplementation.
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri MAK02L14R→Reduced Time to Full Feeding
Meta-analysis of RCTs estimated that the time to full feeds (mean difference [MD], -1.34 days; 95% confidence interval [CI], -1.81 to -0.86; 2 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri UALre-16→NEC Stage II or Higher
≥ stage II NEC (RR, 0.69; 95% CI, 0.47-1.01; 3 RCTs) were reduced but statistically not significant.
Effect
Neutral
Effect size
Moderate
Lactobacillus reuteri UALre-16→Reduced Colitis-Related Mortality
Mortality (RR, 0.79; 95% CI, 0.57-1.09; 3 RCTs) was reduced but statistically not significant.
Effect
Neutral
Effect size
Moderate
Lactobacillus reuteri UALre-16→Reduced Hospitalization Duration
Meta-analysis of RCTs estimated that the duration of hospitalization (-10.77 days; 95% CI, -13.67 to -7.86; 3 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Large
Lactobacillus reuteri UALre-16→Reduced Incidence of Late-Onset Sepsis
Meta-analysis of RCTs estimated that late-onset sepsis (LOS) (relative risk [RR], 0.66; 95% CI, 0.52 to 0.83; 4 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri UALre-16→Reduced Occurrence of Necrotizing Enterocolitis
Both non-RCT studies showed significant improvement in the incidence of NEC with L reuteri supplementation.
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri UALre-16→Reduced Time to Full Feeding
Meta-analysis of RCTs estimated that the time to full feeds (mean difference [MD], -1.34 days; 95% confidence interval [CI], -1.81 to -0.86; 2 RCTs) was reduced in the L reuteri group.
Effect
Beneficial
Effect size
Moderate